Assimos D G, Patterson L C, Taylor C L
Department of Urology, Wake Forest University Medical Center, Winston-Salem, North Carolina.
J Urol. 1994 Dec;152(6 Pt 2):2240-6. doi: 10.1016/s0022-5347(17)31650-6.
In the last decade there have been major advances in endoscopic surgery including ureteroscopy and laparoscopy, both of which may cause ureteral injury. We sought to determine if increased use of these procedures affected the frequency and nature of major iatrogenic ureteral injuries managed at our medical center. From 1980 to 1984 we treated 8 patients with such injuries compared to 19 patients treated from 1985 to 1989. The most recent period corresponded to the institution of ureteroscopy and the use of more aggressive laparoscopic procedures. Of the patients 14 sustained injuries at our center while 13 were referred from other institutions. Between 1985 and 1989 the incidence of injuries per total hospital admissions at risk increased from 4 to 11 per 10,000 (p = 0.0067), the incidence of urological injuries increased from 4 to 23 per 10,000 (p = 0.0071) and the incidence of injuries occurring in gynecologic patients increased from 13 to 41 per 10,000 admissions (p = 0.0385). There was no difference in the incidence of injuries in the general surgical population. From 1980 to 1984 no laparoscopic or ureteroscopic injuries occurred. However, from 1985 to 1989, 25% of gynecologic injuries occurred during laparoscopy and 70% of urological injuries were sustained during ureteroscopic procedures. Depending on the extent of the injury, patients were initially treated with either endourological or open surgical procedures. Good results were obtained in the majority of cases. Contemporary therapeutic strategies for treating patients sustaining ureteral injuries are discussed.
在过去十年中，包括输尿管镜检查和腹腔镜检查在内的内窥镜手术取得了重大进展，而这两种手术都可能导致输尿管损伤。我们试图确定这些手术使用的增加是否影响了在我们医疗中心处理的主要医源性输尿管损伤的频率和性质。1980年至1984年期间，我们治疗了8例此类损伤患者，而1985年至1989年期间治疗了19例。最近一个时期与输尿管镜检查的开展以及更积极的腹腔镜手术的使用相对应。这些患者中，14例在我们中心受伤，13例是从其他机构转诊而来。1985年至1989年期间，每10000例有风险的住院患者中损伤发生率从4例增至11例（p = 0.0067），泌尿外科损伤发生率从每10000例4例增至23例（p = 0.0071），妇科患者中损伤发生率从每10000例入院13例增至41例（p = 0.0385）。普通外科患者的损伤发生率没有差异。1980年至1984年期间未发生腹腔镜或输尿管镜检查导致的损伤。然而，1985年至1989年期间，25%的妇科损伤发生在腹腔镜检查期间，70%的泌尿外科损伤发生在输尿管镜检查过程中。根据损伤程度，患者最初接受了腔内泌尿外科手术或开放手术治疗。大多数病例都取得了良好的效果。文中还讨论了治疗输尿管损伤患者的当代治疗策略。
