Azimuddin K, Milanesa D, Ivatury R, Porter J, Ehrenpreis M, Allman D B
Department of Surgery, Lincoln Medical Center, Bronx, NY 10451, USA.
Injury. 1998 Jun;29(5):363-7. doi: 10.1016/s0020-1383(98)00052-7.
Injury to the ureter is relatively rare. We retrospectively reviewed our experience with 21 cases of ureteric injury from penetrating trauma at the Lincoln Medical Center. Two injuries resulted from stab wounds and 19 from gunshot wounds. Total ureteric disruption occurred in 14 cases, partial transection in four and contusion in three. Preoperative screening was unreliable in accurately predicting the injury with hematuria being present in 66 per cent of cases. Similarly, intravenous urogram was diagnostic in 14 per cent and suspicious in another 42 per cent. Most injuries were diagnosed intraoperatively and exploration of the retro peritoneum remains the only definitive method of excluding ureteric injuries. Most patients were critically ill (mean ISS 27) due to associated injuries (90 per cent). Neither peritoneal contamination associated with hollow viscous injuries nor hypotension adversely affected the healing of ureteric anastomoses. Anastomotic leak developed in three (14 per cent) cases and one of them required operative correction. Another two patients developed infections related to the urinary tract.
输尿管损伤相对少见。我们回顾性分析了林肯医疗中心21例穿透性创伤所致输尿管损伤的病例。其中2例由刺伤引起，19例由枪伤引起。14例输尿管完全断裂，4例部分横断，3例挫伤。术前筛查在准确预测损伤方面并不可靠，66%的病例存在血尿。同样，静脉肾盂造影诊断出损伤的占14%，可疑的占42%。大多数损伤在术中被诊断出来，而探查腹膜后间隙仍然是排除输尿管损伤的唯一确切方法。大多数患者因合并伤病情危重（平均损伤严重度评分27分）（90%）。与中空脏器损伤相关的腹膜污染和低血压均未对输尿管吻合口的愈合产生不利影响。3例（14%）出现吻合口漏，其中1例需要手术矫正。另外2例患者发生了与泌尿系统相关的感染。
