İnan Abdurrahman Hamdi, Budak Adnan, Beyan Emrah, Kanmaz Ahkam Göksel
Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital Izmir, Turkey.
Izmir Provincial Health Directorate, Izmir, Turkey.
J Gynecol Obstet Hum Reprod. 2019 Jan;48(1):45-49. doi: 10.1016/j.jogoh.2018.10.009. Epub 2018 Oct 12.
Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management.
Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed.
Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p<0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff.
Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.
确定接受全腹腔镜子宫切除术患者下尿路损伤的发生率及原因，并检查所采用的处理方法。
纳入2015年1月1日至2017年10月31日期间因良性妇科原因在一家大型转诊中心接受全腹腔镜子宫切除术的患者。接受腹腔镜次全子宫切除术、腹腔镜辅助阴道子宫切除术和机器人辅助腹腔镜子宫切除术的患者不纳入本研究。检查纳入研究的所有患者的医院记录，回顾下尿路损伤的发生率、原因及处理情况。
发现总的下尿路损伤率为2.01%，这些损伤分别评估为膀胱和输尿管损伤。所有膀胱损伤均发生在膀胱子宫间隙分离时膀胱后壁；6例在术中被发现，1例在术后第1天被发现。大多数输尿管损伤病例在术后早期被发现（75%）。膀胱和输尿管损伤患者既往剖宫产和子宫内膜异位症的发生率显著高于对照组（p<0.001）。下尿路损伤患者与对照组在子宫重量、估计失血量、双侧输卵管卵巢切除术、肌瘤的存在及位置以及阴道残端的腹腔镜或阴道闭合方面无显著差异。
腹腔镜子宫切除术对合适的患者可能是一个不错的选择，但对于既往有剖宫产和子宫内膜异位症的患者，术前应详细告知其可能的并发症，并且在分离过程中应小心谨慎。
