Fraga Gustavo P, Borges Gustavo M, Mantovani Mario, Ferreira Ubirajara, Laurito Tiago L, Netto Nelson R
Division of Trauma Surgery, School of Medicine, State University of Campinas, Unicamp, Campinas, Sao Paulo, Brazil.
Int Braz J Urol. 2007 Mar-Apr;33(2):142-8, discussion 149-50. doi: 10.1590/s1677-55382007000200003.
The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality.
From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome.
All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90%) and stab wounds in two (10%). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%). Two ureteral injuries (10%) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group.
A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.
本系列研究旨在报告我们处理输尿管创伤的经验，重点关注早期诊断、正确治疗的重要性以及相关损伤对治疗和病死情况的影响。
1994年1月至2002年12月，共进行了1487例腹部创伤剖腹手术，其中20例患者发现有输尿管损伤，均为穿透伤所致。分析了病历以及有关创伤机制、诊断流程、治疗和结果的信息。
所有患者均为男性，平均年龄27岁。损伤机制为枪伤18例（90%），刺伤2例（10%）。所有穿透性腹部损伤均有剖腹手术的主要指征，术前均未使用排泄性尿路造影或计算机断层扫描。17例（85%）输尿管损伤在术中确诊。2例（10%）输尿管损伤最初漏诊。所有患者均有合并伤。治疗取决于损伤的部位、范围以及确定损伤所需的时间。并发症总发生率为55%。入院时休克、诊断延迟、腹部创伤指数>25、损伤严重度评分>25以及结肠损伤与高并发症发生率相关，但无统计学显著差异。该组无死亡病例。
诊断输尿管损伤需要高度的怀疑指数。穿透伤后对所有腹膜后血肿进行彻底探查应是一种准确的诊断方法；尽管在我们10%的病例中失败了。
