Moussu J, Boulaire J L, Petit J
J Urol (Paris). 1980;86(9):691-4.
The authors report a new case of uretero-uterine fistula and on this basis review the 9 other publications devoted to this subject since 1971. In their own case, the diagnosis was based upon the clinical picture only : permanent flow of urine through the uterine cervix with persistence of normal micturation and left lumbar pain following a caesarian section. Uretero-pyelo-calyceal distension proximal to a low pelvic ureteric stenosis visible by IVU was confirmed by RUP which succeeded in opacifying only the final 3 cm of the ureter. Only peroperative opacification of the ureter showed the fistula tract with the uterus. This was successfully treated by uretero-vesical reimplantation into a psoas bladder. Review of the literature revealed the following points : --The ureter is damaged by blind haemostasis of bleeding at the lateral angle of the hysterotomy, most often on the left, as a result of dextrorotation. --Clinical features consist of the urinary fistula, pain and infectious complications with upper urinary excretory tract obstruction. --The ureteric lesion is situated very low down, between 2 and 4 cm above the ureteric meatus. --Uretero-vesical reimplantation into a tubular vesical flap or a psoas bladder ensures treatment when the kidney remains functional. --The prevention of such lesions may be summarised very briefly : beware of the ureter at the lateral angles of hysterotomy for caesarian section.
作者报告了一例输尿管子宫瘘的新病例，并在此基础上回顾了自1971年以来关于该主题的其他9篇文献。就他们自己的病例而言，诊断仅基于临床表现：剖宫产术后持续有尿液经宫颈流出，排尿正常，但伴有左腰部疼痛。静脉肾盂造影显示盆腔低位输尿管狭窄近端的输尿管肾盂肾盏扩张，逆行输尿管肾盂造影仅使输尿管最后3厘米显影，证实了上述情况。只有术中输尿管显影显示了与子宫的瘘管。通过将输尿管膀胱再植到腰大肌膀胱中成功治愈。文献回顾揭示了以下几点：——子宫切口外侧角出血时盲目止血会损伤输尿管，最常见于左侧，原因是右旋。——临床特征包括尿瘘、疼痛和伴有上尿路梗阻的感染并发症。——输尿管病变位置很低，在输尿管口上方2至4厘米之间。——当肾脏仍有功能时，将输尿管膀胱再植到管状膀胱瓣或腰大肌膀胱中可确保治疗。——此类病变的预防可简要概括为：剖宫产时子宫切口外侧角要小心输尿管。
