Ureteric trauma in gynecologic surgery.
Ureteric trauma in gynecologic surgery.
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DOI：
10.1007/bf01982219
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发表时间：
1998-01-01
期刊：
影响因子：
--
通讯作者：
Noble, J G
中科院分区：
文献类型：
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作者：
Drake, M J;Noble, J G
几乎所有的妇科手术都报告会导致输尿管损伤，非恶性疾病的发生率为0.4%-2.5%。随着越来越多的腹腔镜手术的进行，其发病率也在上升。输尿管损伤的危险因素包括癌症、出血、子宫内膜异位症、粘连和子宫增大。损伤类型包括结扎、挤压、撕裂、撕脱、牵拉和断流。术中诊断可能很明显，但术后表现为腰痛、发热、瘘管或非特异性体征更为常见。相当多的人没有症状。早期诊断是至关重要的，泌尿系统检查应考虑在任何病人谁是没有恢复的预期。术中发现的损伤应在同一手术中修复。延迟确认的损伤正在被保守地处理，在选定的病例中越来越成功。除非损伤严重，否则早期手术修复效果良好。如果诊断及时，修复成功，病人得到周到的治疗，诉讼的可能性就不大。
Nearly all gynecological procedures have been reported to cause ureteric injury, with an incidence of 0.4%-2.5% for non-malignant conditions. The incidence is rising as more ambitious operations are undertaken laparoscopically. Risk factors for ureteric injury include cancer, hemorrhage, endometriosis, adhesions and an enlarged uterus. Types of injury include ligation, crush, laceration, avulsion, stretch and devascularization. The diagnosis may be obvious intraoperatively, but postoperative presentation with loin pain, pyrexia, fistula or non-specific signs is more common. A significant number are asymptomatic. Early diagnosis is vital, and urological investigation should be considered in any patient who is not recovering as expected. Injuries recognized intraoperatively should be repaired during the same operation. Delayed recognized injuries are being managed conservatively with increasing success in selected cases. Early operative repair achieves good results unless the injury is severe. Litigation is less likely if the diagnosis is prompt, repair is successful and the patient is treated with consideration.