Arango Toro O, Bielsa Gali O, Coradellas Angel R, Nohales Taurines G, Carrasco Cánovas N, Herrero Polo M, Gelabert Mas A
Servicio y Cátedra de Urología, Hospital del Mar, Facultad de Medicina, U.A.B. Barcelona.
Actas Urol Esp. 1997 Feb;21(2):133-9.
To conduct a critical review of the etiological, clinical and diagnostic aspects of iatrogenic ureteral lesions caused by various surgical disciplines, primarily focused on the different therapeutical options used.
Between January 1985 and December 1995, 31 iatrogenic lesions of the ureter, 19 female and 10 male, mean age 52 years, were examined. The right ureter was involved in 19 cases and the left one in 12 (2 bilateral). The ureteral lesion resulted from gynaecological surgery in 19 cases (61%), general surgery in 6 (19%), vascular surgery in 3 (10%) and urology in 3 (10%). In 9 cases (29%) it was diagnosed during surgery: in 14 cases (45%) as a result of clinical signs and symptoms and in 8 cases (25%) casually. Surgery was the option chosen in 22 cases, while in 9 conservative treatment was followed.
Surgery solved 91% of damaged ureters, and the best results were seen in patients where lesion was repaired immediately. Conservative treatment was resolutive in all cases.
Gynaecological surgery continues to be the most frequent cause of iatrogenic lesions of the ureter. Ureteral damage in males is now increasing due to the demands from general oncologic surgery, which is usually appreciated by the surgeon which allows immediate repair. Lesions caused by gynaecologic and vascular surgery are commonly overlooked and are diagnosed post-surgically either because of their clinical manifestations or accidentally. The different surgical techniques currently available allow a successful repair of this kind of lesions. Conservative therapy is appropriate in cases that fulfil a series of basic requirements.
对由不同外科专业导致的医源性输尿管损伤的病因、临床及诊断方面进行批判性综述，主要聚焦于所采用的不同治疗方案。
在1985年1月至1995年12月期间，对31例医源性输尿管损伤病例进行了检查，其中女性19例，男性10例，平均年龄52岁。右侧输尿管损伤19例，左侧12例（2例为双侧）。输尿管损伤由妇科手术导致的有19例（61%），普通外科手术导致的6例（19%），血管外科手术导致的3例（10%），泌尿外科手术导致的3例（10%）。9例（29%）在手术过程中被诊断出来；14例（45%）是由于临床症状和体征而被诊断；8例（25%）是偶然发现。22例选择了手术治疗，9例采用了保守治疗。
手术修复了91%的受损输尿管，损伤后立即修复的患者效果最佳。保守治疗在所有病例中均有效。
妇科手术仍然是医源性输尿管损伤最常见的原因。由于普通肿瘤外科手术需求的增加，男性输尿管损伤目前呈上升趋势，而外科医生通常能够及时进行修复。妇科和血管外科手术导致的损伤通常易被忽视，术后要么因其临床表现，要么偶然才被诊断出来。目前可用的不同手术技术能够成功修复这类损伤。在满足一系列基本要求的情况下，保守治疗是合适的。
