Soong Yung-Kuei, Yu Hsing-Tse, Wang Chin-Jung, Lee Chyi-Long, Huang Hong-Yuan
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):600-5. doi: 10.1016/j.jmig.2007.05.004.
To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH).
A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2).
Tertiary care university hospital.
A total of 38 urinary tract injuries were found in 7725 LAVH.
LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach.
The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery.
Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.
评估腹腔镜辅助阴式子宫切除术（LAVH）后泌尿系统损伤的发生率及特点。
一项回顾性研究，评估11年间LAVH手术时发生的所有泌尿系统损伤病例。分析手术指征、损伤部位、诊断时间、治疗方法及长期随访等参数。（加拿大工作组分类II-2）。
三级医疗大学医院。
在7725例LAVH手术中，共发现38例泌尿系统损伤。
LAVH手术及经阴道或经腹途径修复泌尿系统损伤。
LAVH术后泌尿系统损伤的发生率为4.9/1000例手术：膀胱损伤发生率为3.9/1000例手术，输尿管损伤发生率为1.0/1000例手术。既往剖宫产是膀胱损伤最常见的危险因素。96%（29/30）的膀胱损伤在手术中被发现并得到治疗。一半（4/8，50%）的输尿管损伤在手术中被识别。在38例并发症中，28例（75.7%）发生在手术过程中。
LAVH术中多数泌尿系统损伤可被识别，且与术者经验有关。膀胱损伤可经阴道或经腹修复；输尿管损伤可经腹修复。
