輸尿管外傷的改變趨勢

自1988至1997，共經歷了22位患者，24例輸尿管外傷的病例。男性8位，平均年齡30歲，女性14位，平均46歲。傷害發生在左側13側，右側11例。就部位而言，上段輸尿管有7例，下段17例。雙側發生者2例皆在下段輸尿管，2例合併膀胱傷害者亦在下段輸尿管。就傷害原因而言，醫源性傷害者較多，佔19例(79%)，後者又以婦科手術最多58%(11/19)，其次為輸尿管鏡傷害26%(5/19)。若將統計時間分為前5年與後5年，婦科手術所佔比率變化並不大，後5年增加的輸尿管傷害，以內視鏡增加比率最多。治療方面，手術估輸尿管膀胱重新吻合術13例，腎切除5例，輸尿管端端吻合術4例，只做經皮穿腎造廔術及置放雙J型輸尿管導管各1例。臨床徵症若能早期發現，早期治療，效果較佳。手術中發現者，有最高的治療成功率。較晚發現者，合併廔管，感染者，治療效果較差。

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並列摘要

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. Form 1988 to 1997, 22 patients with 24 ureteral injuries were identified. The cause, diagnostic methods and treatments were reviewed. Ureteral injury was defined as any laceration, transaction 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. Ther re cent increase were caused by endoscopic procedures including ureteroscoy 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.

並列關鍵字

ureteral injuries

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輸尿管外傷的改變趨勢

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