Guerriero W G
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
Urol Clin North Am. 1989 May;16(2):237-48.
The management of ureteral injuries resulting from external violence or surgery is usually straightforward and is primarily a problem of recognition and development of a treatment plan that allows either repair of the injury away from the site of pathology or conservative drainage and diversion. However, decisions as to the proper therapy can be complicated by legal, economic, and emotional considerations, which make management of these patients difficult. In the last 5 years, endoscopic manipulation of the ureter for the treatment of stones and stricture has become commonplace. Perforation of the ureter occurs in as many as 20 per cent of cases. Sequelae from these inadvertent injuries are rare, particularly if the injury is managed by proximal diversion with percutaneous nephrostomy and placement of a ureteral stent. Three to ten days of drainage is usually all that is required to heal these injuries. The ureter, of course, may also be avulsed during the course of basket extraction of stone, and open operative correction would then be required. The ureter is a delicate structure. To paraphrase a famous patriot, force in the cause of ureteral stone extraction or ureteral catheterization is a vice!
由外部暴力或手术导致的输尿管损伤的处理通常很直接，主要是一个识别问题以及制定治疗方案的问题，该方案要能实现远离病变部位修复损伤或者进行保守引流和改道。然而，关于恰当治疗方法的决策可能会因法律、经济和情感因素而变得复杂，这使得这些患者的管理很困难。在过去5年里，通过内镜操作输尿管来治疗结石和狭窄已变得很常见。输尿管穿孔在多达20%的病例中会发生。这些意外损伤的后遗症很少见，尤其是如果通过经皮肾造瘘近端改道和放置输尿管支架来处理损伤时。通常只需3至10天的引流就能使这些损伤愈合。当然，在使用取石篮取石过程中输尿管也可能被撕脱，此时则需要进行开放手术矫正。输尿管是一个脆弱的结构。套用一位著名爱国者的话来说，在输尿管取石或输尿管插管过程中使用暴力是一种恶行！
