Ghali A M, El Malik E M, Ibrahim A I, Ismail G, Rashid M
Asir Central Hospital, Abha, Saudi Arabia.
J Trauma. 1999 Jan;46(1):150-8. doi: 10.1097/00005373-199901000-00026.
To define the current causes and the optimal methods of early diagnosis and management of ureteric injuries, both iatrogenic (excluding endourologic) and traumatic, and to determine the outcome of these injuries and which identifiable factors affect this outcome.
A retrospective analysis was performed of all the 35 patients who sustained 40 ureteric injuries over a 5-year period (1991-1996). The methods used for diagnosis and management were reviewed. The outcome was assessed in terms of preservation of renal function.
The study group was composed of 28 patients with 32 iatrogenic injuries and 7 patients with 8 injuries caused by external trauma. Gynecologic procedures accounted for 63% (20 of 32) of the iatrogenic injuries, whereas motor vehicle crashes accounted for 75% of the external injuries (6 of 8 injuries). The successful diagnostic rate for direct inspection (intraoperatively), intravenous urogram, retrograde pyelogram, and anterograde pyelogram were 33% for the former two and 100% for the latter two. Treatment consisted of primary open repair in 26 cases, a staged procedure in 7 cases, and endoscopic stenting in 5 cases. Of 36 cases with follow-up, complications developed in 9 cases (25%), 7 cases of which were corrected surgically. Overall incidence of nephrectomy was 8%, and the factors that seemed to affect the outcome adversely were pediatric age (< or =12 years), injury to upper ureter, delay in recognition, the presence of a urinoma, and/or associated organ injury.
Iatrogenic trauma is the leading cause of ureteric injuries. The single controllable factor adversely affecting the outcome of this rather uncommon injury seems to be delayed diagnosis. Wound inspection and intravenous urogram are not reliable for early and accurate diagnosis, and a retrograde pyelogram or an anterograde pyelogram may be needed. Uncontrollable factors adversely affecting the outcome include young age, injury to upper ureter, and associated injuries all seen in association with external trauma rather than iatrogenic injuries.
明确医源性（不包括腔内泌尿外科手术相关）及外伤性输尿管损伤的当前病因、早期诊断和处理的最佳方法，并确定这些损伤的预后以及哪些可识别因素会影响该预后。
对1991年至1996年5年间发生40例输尿管损伤的35例患者进行回顾性分析。回顾了诊断和处理所采用的方法。根据肾功能的保留情况评估预后。
研究组包括28例发生32例医源性损伤的患者和7例发生8例外伤所致损伤的患者。医源性损伤中63%（32例中的20例）由妇科手术引起，而外伤所致损伤中75%（8例中的6例）由机动车碰撞引起。直接检查（术中）、静脉肾盂造影、逆行肾盂造影和顺行肾盂造影的成功诊断率，前两者为33%，后两者为100%。治疗包括26例一期开放修复、7例分期手术和5例内镜支架置入术。在36例有随访的病例中，9例（25%）出现并发症，其中7例经手术纠正。肾切除的总体发生率为8%，似乎对预后有不利影响的因素包括儿童年龄（≤12岁）、上段输尿管损伤、诊断延迟、存在尿外渗和/或合并器官损伤。
医源性创伤是输尿管损伤的主要原因。对这种相对不常见损伤的预后产生不利影响的单一可控因素似乎是诊断延迟。伤口检查和静脉肾盂造影对于早期准确诊断不可靠，可能需要逆行肾盂造影或顺行肾盂造影。对预后产生不利影响的不可控因素包括年轻、上段输尿管损伤以及与外伤而非医源性损伤相关的合并损伤。
