DeWitt Daughtry Family Department of Surgery, Leonard M, Miller School of Medicine, University of Miami/Jackson Memorial Hospital, Ryder Trauma Center, Miami, FL, USA.
Scand J Trauma Resusc Emerg Med. 2010 Feb 3;18:6. doi: 10.1186/1757-7241-18-6.
Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management.
Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%.
The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.
输尿管创伤罕见，不到所有泌尿科创伤的 1%。然而，漏诊的输尿管损伤可能导致严重的发病率和死亡率。本文的目的是回顾 1961 年以来的文献，主要目的是展示迄今为止关于输尿管创伤的最大医学文献综述。在处理输尿管损伤时，几个解剖学和生理学方面的考虑因素至关重要。
共回顾了 81 篇关于创伤性输尿管损伤的文章。对这些研究的数据进行了编译和分析。研究人群主要是年轻男性。近端输尿管是最常受伤的部位。90.4%的患者存在合并伤。入院尿检仅显示 44.4%的患者血尿。42.8%的病例在入院时或手术室的静脉肾盂造影（IVU）未能诊断输尿管损伤。输尿管对端吻合术（带或不带留置支架）是创伤外科医生和泌尿科医生的首选手术方法（59%）。36.2%的病例发生并发症。死亡率为 17%。
成人输尿管损伤的机制更常见于穿透性损伤而非钝性损伤。输尿管的上三分之一比中三分之一和下三分之一更常受伤。常伴有合并伤。当 CT 扫描和逆行肾盂造影一起进行时，能准确识别输尿管损伤。输尿管对端吻合术（带或不带留置支架）是创伤外科医生和泌尿科医生的首选手术方法。诊断延迟与预后不良相关。
