Nnabugwu Ii, Amu Oc
Dept of surgery, Federal Medical Centre, Asaba, Delta State, Nigeria.
Dept of surgery, Enugu State University Teaching Hospital, Enugu. Enugu State, Nigeria.
J West Afr Coll Surg. 2011 Jul;1(3):98-108.
Iatrogenic ureteric injury(IUI) in open obstetric and gynaecological surgeries is uncommon, with an incidence of 0.4-2.5%. It is however less uncommon in some specific vaginal and urethral suspension surgeries. The left ureter is more commonly damaged in the pelvis than the right ureter. The common mechanisms of injury include ligation, transection and crushing. Most of these injuries are unnoticed at the primary surgery, but are recognized in the immediate post-operative period. Iatrogenic ureteric injury increases morbidity, though mortality is rare.
A total of six patients had iatrogenic ureteric injuries during open pelvic operations in this study between January 2009 and December 2010. All the patients had a mean age of 38.5years and a range of 27-50 years. The primary surgery for three of the cases were done by consultant gynaecologists, two by medical officers who were yet to undergo residency training, while the status of the surgeon in one case could not be ascertained. The left ureter was injured in 5(83%) patients, with ligation being the commonest mechanism of injury in 83% of cases. Recognition of the ureteric injuries was in the post-operative period in all the cases in this report. The commonest presenting feature was leakage of urine via a uretero-vaginal fistula in 67% of cases and through the surgical wound in one(17%) patient.
Iatrogenic ureteric injuries do complicate pelvic surgeries in this environment and often present as urinary fistula in the immediate post operative period; majority are missed intra-operatively.
开放性妇产科手术中发生医源性输尿管损伤（IUI）的情况并不常见，发生率为0.4%-2.5%。然而，在某些特定的阴道和尿道悬吊手术中，这种情况并不那么罕见。在盆腔中，左侧输尿管比右侧输尿管更易受损。常见的损伤机制包括结扎、横断和挤压。这些损伤大多在初次手术时未被发现，但在术后即刻被识别。医源性输尿管损伤会增加发病率，尽管死亡率很低。
在本研究中，2009年1月至2010年12月期间，共有6例患者在开放性盆腔手术中发生医源性输尿管损伤。所有患者的平均年龄为38.5岁，年龄范围为27-50岁。其中3例的初次手术由妇科顾问医生完成，2例由尚未接受住院医师培训的医务人员完成，而1例患者的手术医生情况不明。5例（83%）患者的左侧输尿管受损，83%的病例中，结扎是最常见的损伤机制。本报告中所有病例的输尿管损伤均在术后被识别。最常见的表现特征是67%的病例通过输尿管阴道瘘漏尿，1例（17%）患者通过手术伤口漏尿。
在这种情况下，医源性输尿管损伤确实会使盆腔手术复杂化，并且在术后即刻常表现为尿瘘；大多数损伤在术中被漏诊。
