Chou Y H, Chen M T, Huang C H
Department of Urology, Kaohsiung Medical College, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1998 Dec;14(12):751-3.
Ureteral injury is a potential complication of any abdominal or pelvic surgery. Gynecological surgery has traditionally accounted for most injuries. In the last decade, there have been major advances in endoscopic surgery including ureteroscopy and laparoscopy, both of which may cause ureteral injury. Increased use of these procedures change the nature of ureteral injuries. From 1988 to 1997, 22 patients with 24 ureteral injuries were identified. The causes, diagnostic methods and treatments were reviewed. Ureteral injury was defined as any laceration, transection or ligation of the ureter that required an unexpected procedure for repair, stent or drainage. In 24 ureteral injuries, there were 20 unilateral cases and 2 bilateral cases eight men (33%) were 15 to 43 years old (mean age 30), and 14 women including 2 case of bilateral lesion (67%) were 30 to 75 years old (mean age of 46). The injuries were on the right side in 11 cases (46%), left side 13 cases (54%), and in the upper, and lower third of the ureter in 7 (29%) and 17 cases (71%), respectively. Bilateral injuries were all in the lower ureter and another 2 cases of lower ureteral injuries were combined with bladder injuries. In the cases of ureteral injuries, iatrogenic injuries accounted for 19 cases (79%). Of these, urological surgery, laparoscopic surgery, ureteroscopic procedures and gynecological surgery accounted for 1 (4%), 2(8%), 5(21%) and 11 cases (46%) respectively. Between 1988 and 1992, there were 7 cases, and after 1993, there were 17 cases of ureteral injuries. The injuries caused by trauma and gynecological surgery remained stable in the 2 period. The recent increases were caused by endoscopic procedures including ureteroscopy and laparoscopy. Of the 24 cases, 13 cases (54%) were managed by ureteroneocystostomy, 5 cases (21%) by nephrectomy, 4 cases (17%) by ureteroureterotomy, 1 case by PCN and 1 case by double-J catheter stenting only. The early recognition and repair at injury allow for better results with fewer complications. Delayed finding or commitant infection may lead to failure of reconstructive procedure and lead to nephrectomy.
输尿管损伤是任何腹部或盆腔手术的潜在并发症。传统上，妇科手术导致的输尿管损伤最为常见。在过去十年中，包括输尿管镜检查和腹腔镜检查在内的内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。这些手术的使用增加改变了输尿管损伤的性质。1988年至1997年期间，共确定了22例患者的24处输尿管损伤。对其病因、诊断方法及治疗进行了回顾。输尿管损伤定义为输尿管的任何撕裂、横断或结扎，需要进行意外的修复、置入支架或引流手术。在24处输尿管损伤中，单侧损伤20例，双侧损伤2例。8名男性（33%）年龄在15至43岁之间（平均年龄30岁），14名女性（包括2例双侧损伤患者，占67%）年龄在30至75岁之间（平均年龄46岁）。损伤位于右侧11例（46%），左侧13例（54%）；位于输尿管上三分之一段7例（29%），下三分之一段17例（71%）。双侧损伤均位于输尿管下段，另有2例输尿管下段损伤合并膀胱损伤。在输尿管损伤病例中，医源性损伤占19例（79%）。其中，泌尿外科手术、腹腔镜手术、输尿管镜手术和妇科手术分别占1例（4%）、2例（8%）、5例（21%）和11例（46%）。1988年至1992年有7例输尿管损伤，1993年后有17例。创伤和妇科手术导致的损伤在这两个时期保持稳定。近期的增加是由包括输尿管镜检查和腹腔镜检查在内的内镜手术所致。24例中，13例（54%）行输尿管膀胱吻合术，5例（21%）行肾切除术，4例（17%）行输尿管输尿管吻合术，1例经皮肾穿刺造瘘术，1例仅置入双J导管支架。损伤时早期识别并修复可获得更好的效果，并发症更少。发现延迟或合并感染可能导致重建手术失败并导致肾切除术。
