摘要
目的探讨局部晚期宫颈癌患者行腹腔镜手术致输尿管损伤的原因、注意事项及处理。方法回顾性分析2014年1月至2018年12月,本院因局部晚期宫颈癌行腹腔镜宫颈癌根治术致输尿管损伤患者临床资料。结果 54例局部晚期宫颈癌行腹腔镜手术患者,术中输尿管损伤1例,腹腔镜下行右输尿管端端吻合修补加输尿管支架植入术;术后输尿管积水8例,输尿管镜下行输尿管支架植入术;术后输尿管阴道瘘4例,1例双侧输尿管瘘患者输尿管镜下双侧输尿管支架置入失败后改开腹,左侧行输尿管支架置入缝合术,右侧行损伤段切除后端端吻合术。1例右侧输尿管瘘患者行输尿管镜下右侧输尿管支架置入术。1例左侧输尿管瘘患者输尿管镜插管失败后行开腹膀胱瓣代输尿管术。另1例右侧输尿管瘘患者,术后14 d出现漏尿症状未及时就诊,术后1个月方来院就诊,右输尿管插管失败后行经皮右肾造瘘术,术后6个月行右输尿管膀胱再植术。所有患者均在输尿管置管术后3~6个月取出输尿管支架,恢复良好。结论输尿管损伤应早发现、早处理。局部晚期宫颈癌因病灶大、手术范围大,输尿管损伤风险大,行手术治疗应慎重。
Objective To investigate the causes,precautions,and treatment of ureteral injury associated with laparoscopic radical surgery for locally advanced cervical cancer.Methods The clinical data of patients with locally advanced cervical cancer suffering from ureteral injury occurred during or after laparoscopic radical hysterectomy and pelvic lymphadenectomy performed at our hospital between January 2014 and December 2018 were retrospectively analyzed.Results Totally,fifty-four patients with locally advanced cervical cancer underwent laparoscopic radical surgery.Intraoperative ureteral injury occurred in one woman,for whom laparoscopic ureteral end-to-end anastomosis and stent implantation were performed immediately.Postoperative hydroureter was observed in eight patients and treated by ureteral stent implantation under ureteroscopy.There were four cases of postoperative ureteral fistula:one patient with bilateral ureteral fistula was,after failing in placing bilateral ureteral stents under ureteroscopy,subjected to laparotomy for stent implantation into the left ureter and end-to-end anastomosis of the right ureter;one patient with right u-reteral fistula underwent ureteroscopic ureteral stenting;one patient with left ureteral fistula received a Iapa-rotomic ureteroplasty with bladder wall flap;another patient with right ureteral fistula who had symptoms of leaking urine 14 days after surgery,but sought treatment until one month after surgery,underwent percutaneous nephrostomy after a failed ureteral intubation,followed by a ureterovesical replantation after six months.All patients who had received ureteral catheterization underwent extraction of ureteral stents after three to six months and recovered well.Conclusions The radical surgery for locally advanced cervical can-cer requires an extensive surgical procedure because of the bulky size of the lesion,which is associated with an increased risk of ureteral injury.With early detection and proper treatment,a good prognosis of the ureteral injury can be expected.
作者
白瑞
徐晓涵
李凯丽
杨萍
Bai Rui;Xu Xiaohan;Li Kaili;Yang Ping(Department of Obstetrics and Gynecology,the First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi 832008,China)
出处
《中国医师杂志》
CAS
2020年第2期175-178,共4页
Journal of Chinese Physician
基金
新疆生产建设兵团科技攻关项目(2017DB012)
石河子大学科技攻关项目(CGZH201702)。
关键词
宫颈肿瘤
腹腔镜检查
手术并发症
输尿管损伤
Uterine cervical neoplasms
Laparoscopy
Operative complications
Ureteral injury
