Delacroix Scott E, Winters J C
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Clin Colon Rectal Surg. 2010 Jun;23(2):104-12. doi: 10.1055/s-0030-1254297.
Iatrogenic injury to the urinary tract during colorectal surgery can be a source of significant morbidity. Although most cases of ureteral injury occur in patients without significant risk factors, the incidence of urinary tract injuries increases in patients with prior pelvic operations, inflammatory bowel disease, infection, and in patients with extensive neoplasms causing distortion of normal surgical planes. The most commonly injured locations are the ureter, bladder, and urethra. Mechanisms of injury include ligation, transection, devascularization, and energy induced. Early identification of urinary tract injuries is paramount in minimizing morbidity and preservation of renal function. Anatomic considerations for preventing injuries, diagnostic techniques for localizing and staging injuries, as well as reconstructive techniques and principles of repair are discussed.
结直肠手术期间的医源性尿路损伤可能是严重发病的根源。虽然大多数输尿管损伤病例发生在无明显危险因素的患者中，但既往有盆腔手术史、炎症性肠病、感染的患者以及患有导致正常手术平面变形的广泛性肿瘤的患者，尿路损伤的发生率会增加。最常受损的部位是输尿管、膀胱和尿道。损伤机制包括结扎、横断、血运障碍和能量诱导。早期识别尿路损伤对于将发病率降至最低和保护肾功能至关重要。本文讨论了预防损伤的解剖学考虑因素、损伤定位和分期的诊断技术，以及重建技术和修复原则。
