妇产科手术致输尿管阴道瘘的单中心临床处理
发布时间：2018-10-15 19:36
【摘要】：目的:探讨妇产科手术致输尿管阴道瘘的病因和特点,总结单中心输尿管损伤的诊治经验和措施。方法:对2008年1月~2016年1月在四川大学华西医院行妇产科手术所致的57例输尿管损伤患者的临床资料进行回顾性分析。观察指标包括手术时间、术后并发症等,随访患者的治疗效果。结果:50例(87.7%)行输尿管膀胱再植手术,其中开放手术42例,腹腔镜手术8例;7例(12.3%)行膀胱翻瓣输尿管成形术。平均手术时间为85(60~145)min。患者均无严重术后并发症,5例术后出现伤口感染。术后平均随访时间为3.5个月(1个月~3年),患者出院后1个月门诊复查肾功能和泌尿系B超。随访期间,所有患者通过影像学证实无输尿管瘘和输尿管狭窄征象。结论:妇产科手术致输尿管阴道瘘在女性泌尿道生殖瘘中呈逐渐上升趋势,其主要病因为妇科肿瘤行子宫全切术。CT尿路造影(CTU)能够快速而又准确地诊断输尿管损伤,尝试放置输尿管支架管失败后,早期输尿管膀胱再植仍是输尿管阴道瘘处理的最佳方式,腹腔镜输尿管膀胱再植术因创伤小、恢复快值得进一步推广。
[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.
【作者单位】： 四川大学华西医院泌尿外科 四川大学华西泌尿外科研究所;
【分类号】：R71
[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.
【作者单位】： 四川大学华西医院泌尿外科 四川大学华西泌尿外科研究所;
【分类号】：R71
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