Selzman A A, Spirnak J P
Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Urol. 1996 Mar;155(3):878-81. doi: 10.1016/s0022-5347(01)66332-8.
We reviewed the causes, treatment and morbidity associated with iatrogenic ureteral injuries.
From 1972 to 1992 the charts of all patients with the diagnosis of iatrogenic ureteral injury were reviewed and 156 injuries were identified.
Urological, gynecological and general surgical procedures accounted for 70 (42%), 56 (34%) and 39 (24%) injuries, respectively. Of the injuries 91% occurred in the lower third, 7% in the middle third and 2% in the upper third of the ureter, respectively. Among the urological lesions 77% were identified at injury compared to only 33% of the nonurological cases. Nonurological and urological ureteral injuries detected postoperatively required 1.8 and 1.6 procedures, respectively, compared to only 1.2 procedures in both groups (p < 0.0006 and p < 0.013) when the injuries were detected immediately at operation.
Endourological procedures are the most common cause of iatrogenic ureteral injuries. When identified at injury and treated properly such injuries seldom lead to loss of renal function.
我们回顾了医源性输尿管损伤的病因、治疗及发病率。
回顾1972年至1992年期间所有诊断为医源性输尿管损伤患者的病历，共识别出156例损伤。
泌尿外科、妇科及普通外科手术导致的损伤分别为70例（42%）、56例（34%）和39例（24%）。损伤分别有91%发生在输尿管下三分之一段，7%发生在中三分之一段，2%发生在上三分之一段。泌尿外科损伤中77%在损伤时被识别，而非泌尿外科病例仅为33%。术后发现的非泌尿外科和泌尿外科输尿管损伤分别需要1.8次和1.6次手术，而术中立即发现损伤的两组患者均仅需1.2次手术（p<0.0006和p<0.013）。
腔内泌尿外科手术是医源性输尿管损伤最常见的原因。损伤时若能识别并得到妥善治疗，此类损伤很少导致肾功能丧失。
