Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2019 Feb;133(2):313-322. doi: 10.1097/AOG.0000000000003067.
Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.
肠和膀胱损伤相对较少见,但开放和微创妇科手术都可能会出现严重的并发症。与大多数手术并发症一样,及时发现是将严重患者发病率和死亡率降至最低的关键。此类损伤的诊断需要仔细注意手术入路和解剖技术,并采用辅助诊断方式。肠和膀胱的修复可以通过机器人、腹腔镜或剖腹手术进行。这些损伤的修复需要了解解剖层次和缝合材料,并进行测试以确保实现完整和安全的修复。根据主刀医生的技能和专业知识,鼓励咨询专家的参与。肠或膀胱损伤后的术后护理需要监测并发症,包括修复部位漏、脓肿和瘘管形成。