Klap J, Phé V, Chartier-Kastler E, Mozer P, Bitker M-O, Rouprêt M
Service d'urologie, université Paris VI, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
Prog Urol. 2012 Nov;22(15):913-9. doi: 10.1016/j.purol.2012.05.003. Epub 2012 Jun 27.
Ureteric injuries (IU) are common complications occurring during abdomino-pelvic surgical procedures. Our aim was to review risk factors, treatment and methods of prevention of these iatrogenic UI.
A literature review in English and French by Medline(®) was performed using the keywords: ureter; iatrogenic; injury; ureteroscopy; morbidity and endoscopy.
The analysis of the epidemiology of IU shows that the first two causes are gynecological and urological surgery. In 80% of cases, the pelvic ureter was concerned. Mechanisms of injury were essentially ligation, section and ischemia by altering the ureteral vasculature. The main risk factors found were pelvic inflammation (endometriosis, radiation…) and the occurrence of bleeding during surgery. In the presence of risk factors, placing a double J stent or a CT may be useful preoperatively. The choice of reparation technique depended on the location of the PU, the circumstances of the occurrence and experience of the surgical team.
Pelvic surgery is a provider of iatrogenic PU. Knowledge of the management of PU once occurred must be mastered before carrying out any risk surgery.
输尿管损伤（IU）是腹部盆腔外科手术中常见的并发症。我们的目的是回顾这些医源性输尿管损伤的危险因素、治疗方法及预防措施。
通过医学在线数据库（Medline®）使用关键词“输尿管；医源性；损伤；输尿管镜检查；发病率和内窥镜检查”进行英文和法文文献综述。
对输尿管损伤的流行病学分析表明，前两大病因是妇科和泌尿外科手术。80%的病例涉及盆腔输尿管。损伤机制主要是通过改变输尿管血管系统导致结扎、切断和缺血。发现的主要危险因素是盆腔炎症（子宫内膜异位症、放疗……）以及手术中出血的发生。存在危险因素时，术前放置双J支架或进行CT检查可能有用。修复技术的选择取决于盆腔输尿管的位置、损伤发生的情况以及手术团队的经验。
盆腔手术是医源性盆腔输尿管损伤的一个来源。在进行任何有风险的手术之前，必须掌握盆腔输尿管损伤一旦发生后的处理知识。
