Li Xinfei, Yang Kunlin, Ding Guangpu, Zou Xiaofeng, Ye Liefu, Wu Jinfeng, Zhang Peng, Fang Dong, Hao Han, Li Zhe, Zhu Hongjian, Li Xuesong, Jiang Haowen, Wang Kunjie, Zhou Liqun, Li Hong
Department of Urology, Peking University First Hospital. Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Transl Androl Urol. 2022 Jun;11(6):794-802. doi: 10.21037/tau-21-998.
To investigate the common etiologies, characteristics, and management of ureteric injury.
A nationwide study was performed in 38 medical centers from Mar 2017 to Mar 2019. The data of patients with ureteric injury were retrospectively collected.
Overall, 294 patients were included in this study. Ten cases (3.4%) were due to abdominal injuries, and 284 cases (96.6%) were due to iatrogenic injuries, including 48.6% from urological procedures, 41.9% from gynecological procedures, 6.3% from general surgery, and 3.2% from other treatments. Most urological injuries (79.7%) were caused by endourological procedures. Injury occurred in the distal ureter in 178 cases (60.5%), the mid-ureter in 31 cases (10.5%), and the proximal ureter in 85 cases (28.9%). Only 51 patients (17.3%) were diagnosed immediately during primary surgery. Immediate ureter reconstruction was performed in 30 patients (58.8%), while delayed urinary diversion was performed in 148 patients (60.9%) in the delayed diagnosis group. The side and the location of the injury were different between the urological and nonurological injury groups (P<0.001). Ureteric injuries were diagnosed timelier in the urological group than in the nonurological group (P=0.037).
Iatrogenic injury was the most common cause of ureteric injury. The majority of iatrogenic injuries were caused by urological procedures and were primarily due to aggressive endourological techniques. Depending on the condition of the patient, the time of diagnosis, and the location and length of the ureteric injury, different management strategies should be applied.
探讨输尿管损伤的常见病因、特点及处理方法。
2017年3月至2019年3月在全国38个医学中心开展一项研究。回顾性收集输尿管损伤患者的数据。
本研究共纳入294例患者。10例（3.4%）因腹部损伤导致，284例（96.6%）因医源性损伤导致，其中48.6%源于泌尿外科手术，41.9%源于妇科手术，6.3%源于普通外科手术，3.2%源于其他治疗。大多数泌尿外科损伤（79.7%）由腔内泌尿外科手术引起。178例（60.5%）损伤发生在输尿管远端，31例（10.5%）发生在输尿管中段，85例（28.9%）发生在输尿管近端。仅51例患者（17.3%）在初次手术时即被诊断。30例（58.8%）患者立即进行了输尿管重建，而延迟诊断组148例患者（60.9%）进行了延迟尿流改道。泌尿外科损伤组与非泌尿外科损伤组在损伤侧别及部位方面存在差异（P<0.001）。泌尿外科组输尿管损伤的诊断比非泌尿外科组更及时（P=0.037）。
医源性损伤是输尿管损伤最常见的原因。大多数医源性损伤由泌尿外科手术引起，主要是由于激进的腔内泌尿外科技术。应根据患者情况、诊断时间以及输尿管损伤的部位和长度，采用不同的处理策略。
