Lee Joong Shik, Choe Jin Ho, Lee Hyo Serk, Seo Ju Tae
Department of Urology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.
Korean J Urol. 2012 Nov;53(11):795-9. doi: 10.4111/kju.2012.53.11.795. Epub 2012 Nov 14.
Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery.
We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury.
Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy.
Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.
盆腔手术中泌尿系统损伤屡见不鲜。诊断和治疗不当可能导致严重并发症及副作用。本研究探讨妇产科手术后泌尿系统并发症的临床特征。
我们收集了2007年至2011年期间47318例妇产科手术病例。纳入97例有泌尿系统并发症的患者。本研究评估了泌尿系统损伤的致病疾病、手术方式、类型及治疗方法。
这97例患者中，69例为膀胱损伤，23例为输尿管损伤，2例为膀胱阴道瘘，2例为输尿管阴道瘘，1例为肾损伤。就特定手术的损伤率而言，腹腔镜辅助根治性阴道子宫切除术最高，98例中有3例，其次是根治性腹式子宫切除术，539例中有15例。所有69例膀胱损伤患者均在手术中进行了一期缝合，无并发症发生。14例早期诊断为输尿管损伤的患者中，7例插入了输尿管导管，5例行输尿管输尿管吻合术，2例行输尿管膀胱吻合术。9例延迟诊断为输尿管损伤的患者中，3例插入输尿管导管，4例行输尿管输尿管吻合术，2例行输尿管膀胱吻合术。
膀胱损伤是妇产科手术中最常见的泌尿系统损伤，其次是输尿管损伤。输尿管损伤患者的损伤状态多样、诊断困难且完全治愈所需时间长得多。早期诊断和泌尿外科干预对于取得更好的治疗效果很重要。
