發(fā)布時(shí)間：2018-10-15 19:36

【摘要】：目的:探討婦產(chǎn)科手術(shù)致輸尿管陰道瘺的病因和特點(diǎn),總結(jié)單中心輸尿管損傷的診治經(jīng)驗(yàn)和措施。方法:對(duì)2008年1月~2016年1月在四川大學(xué)華西醫(yī)院行婦產(chǎn)科手術(shù)所致的57例輸尿管損傷患者的臨床資料進(jìn)行回顧性分析。觀察指標(biāo)包括手術(shù)時(shí)間、術(shù)后并發(fā)癥等,隨訪患者的治療效果。結(jié)果:50例(87.7%)行輸尿管膀胱再植手術(shù),其中開(kāi)放手術(shù)42例,腹腔鏡手術(shù)8例;7例(12.3%)行膀胱翻瓣輸尿管成形術(shù)。平均手術(shù)時(shí)間為85(60~145)min�；颊呔鶡o(wú)嚴(yán)重術(shù)后并發(fā)癥,5例術(shù)后出現(xiàn)傷口感染。術(shù)后平均隨訪時(shí)間為3.5個(gè)月(1個(gè)月~3年),患者出院后1個(gè)月門診復(fù)查腎功能和泌尿系B超。隨訪期間,所有患者通過(guò)影像學(xué)證實(shí)無(wú)輸尿管瘺和輸尿管狹窄征象。結(jié)論:婦產(chǎn)科手術(shù)致輸尿管陰道瘺在女性泌尿道生殖瘺中呈逐漸上升趨勢(shì),其主要病因?yàn)閶D科腫瘤行子宮全切術(shù)。CT尿路造影(CTU)能夠快速而又準(zhǔn)確地診斷輸尿管損傷,嘗試放置輸尿管支架管失敗后,早期輸尿管膀胱再植仍是輸尿管陰道瘺處理的最佳方式,腹腔鏡輸尿管膀胱再植術(shù)因創(chuàng)傷小、恢復(fù)快值得進(jìn)一步推廣。
[Abstract]:Objective: to investigate the etiology and characteristics of ureterovaginal fistula caused by gynecology and obstetrics surgery, and to summarize the experience and measures in the diagnosis and treatment of single center ureteral injury. Methods: the clinical data of 57 cases of ureteral injury caused by gynecology and obstetrics surgery in Huaxi Hospital of Sichuan University from January 2008 to January 2016 were retrospectively analyzed. The observation indexes included operation time, postoperative complications, and the effect of follow-up. Results: 50 cases (87.7%) underwent ureteral bladder replantation, including open operation in 42 cases, laparoscopic surgery in 8 cases, and bladder valvuloplasty in 7 cases (12.3%). Average operative time was 85 (60 / 145) min. There were no serious postoperative complications and 5 cases had postoperative wound infection. The average follow-up time was 3.5 months (1 month ~ 3 years). During follow-up, no ureteral fistula and ureteral stricture were confirmed by imaging in all patients. Conclusion: ureterovaginal fistula caused by gynecology and obstetrics surgery is increasing in female genitourinary fistula, the main cause of which is total hysterectomy for gynecological tumors. CT urography (CTU) can diagnose ureteral injury quickly and accurately. After the failure of ureteral stent placement, early ureterocystectomy is still the best way to manage ureterovaginal fistula. Laparoscopic ureteral bladder replantation is worth popularizing because of its small trauma and quick recovery.
【作者單位】： 四川大學(xué)華西醫(yī)院泌尿外科 四川大學(xué)華西泌尿外科研究所;
【分類號(hào)】：R71

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