Sigel A, Egilmez A N, Höhn W
Urologe A. 1984 Jan;23(1):30-4.
Based on 10 own cases during the past 12 years, and a review of the literature, the subject is divided into classification and correlations, morbidity, aetiology, traumatogenesis and pathomechanisms, pathological anatomy and physiology, diagnostical pathways, therapy and results. There are closed and open injuries of the ureter, isolated and combined ones, and among the latter, combined related and not related. This injury is rare in general; in overseas countries, more often the open and in Central Europe, mostly the closed trauma can be seen. The indirect rupture of the ureter happens by hyperlordosis, the direct rupture by wheel lesion. The prevalence of youth for the indirect mechanism of the injury is explained by the hyperextensibility of the lumbar region in juveniles. Usually, the rupture is located proximally, a distal rupture (pelvic fracture) is an exception. Criteria of the closed injury are urinoma within Gerota's fascia and local resorption, later infection or urosepsis. The open injury is marked additionally by abdominal resorption of urine, followed by uremia and peritonitis. Delayed diagnosis is common, as the trauma causes few symptoms initially. Further, it is often obscured by concomitant injuries. For therapy, the rupture must be closed operatively by suture and splint. The operative approach follows usually the lumbar, but in cases of concomitant abdominal injury the abdominal route. Loss of kidney occurs in 20% and lethal outcome in 10%.
基于过去12年里的10例自身病例以及文献回顾，该主题分为分类与关联、发病率、病因、创伤发生与发病机制、病理解剖与病理生理、诊断途径、治疗与结果。输尿管损伤有闭合性和开放性之分，有孤立性和合并性损伤，在合并性损伤中又有相关和不相关之分。总体而言，这种损伤较为罕见；在国外，开放性损伤较为常见，而在中欧，大多可见闭合性创伤。输尿管间接破裂由腰椎前凸过度引起，直接破裂由车轮损伤导致。损伤间接机制在年轻人中更为常见，这是因为青少年腰椎区域具有过度伸展性。通常，破裂位于近端，远端破裂（骨盆骨折）则为例外。闭合性损伤的标准是肾周筋膜内尿瘤及局部吸收，随后发生感染或尿脓毒症。开放性损伤还表现为尿液经腹腔吸收，继而出现尿毒症和腹膜炎。延迟诊断很常见，因为创伤最初引起的症状较少。此外，它常被合并伤掩盖。对于治疗，破裂必须通过缝合和固定进行手术修复。手术入路通常采用腰部，但在合并腹部损伤的情况下则采用腹部途径。20%的病例会出现肾丧失，10%的病例会导致死亡。
