闭合性输尿管破裂6例的诊治体会.DOCVIP

临床医学论文-闭合性输尿管破裂6例的诊治体会 ??????????????? 作者：邓争鸣，高成绩，李庆文，王志峰 【关键词】? ,,输尿管破裂；,,影像学诊断；,,外科手术 　　摘要：目的：探讨闭合性输尿管破裂的临床特征。方法：回顾分析6例闭合性输尿管破裂的临床资料。结果：2例在早期剖腹探查中明确诊断，1例于伤后d2明确诊断，另3例在伤后5～25d才明确诊断。3例早期行一期输尿管或输尿管肾盂端端吻合术，2例于损伤3个月后行尿液性囊肿切除输尿管端端吻合术，1例行单纯尿液引流。随访4个月至5年，均行静脉肾盂造影、B超、血Cr、BUN检查；2例肾轻度积水，1例吻合口轻度狭窄，余3例均正常。结论：尿外渗、肾积水是输尿管破裂的主要表现，大剂量静脉肾盂造影及逆行插管输尿管造影、CT检查对本病的诊断有重要价值。急诊手术探查，争取一期修复有利于提高疗效。 　　关键词：? 输尿管破裂；? 影像学诊断；? 外科手术 　　An Experience on 6 Cases Closed Ureteral Rupture 　　　Abstract：Objective：To study the clinical characteristics of closed ureteral ruputure. Method：Review and analysis the clinical datas 6 cases closed ureteral ruputure. Result：2 cases were made definite diagnosis among celiotomy exploratory, 1 case was diagnosed next day after injury, Another 3 cases werent made definite diagnosis until 5～25 days later. 3 cases were taken ureter or ureter to renal pelvis end-to-end one-stage anastomosis early,2 cases were taken urinary cyst resection and ureter end-to-end anastomosis three months later,1 case performed extravsation of urine drainage only. The follow-up period ranged from 4 months to 5 years ，All of them were taken intravenous urography(IVU)、B-ultrosonography、blood Cr 、BUN examination ；2 cases were found slight hydronephrosis，1 case was found slight anastomotic stenosis, The other 3 cases are normal. Conclusion: Urinary extravsation、hydronephrosis are the main characteristics of ureteral rupture，The IVU of great dose and retrograde pyelograpgy、CT have important value on ureteral rupture diagnosis. The emergency operation exploratory ,One-stage repair must improve the curative effect . 　　Key words：? Ureteral rupture；? Imaging diagnosis；? Surgical operation??? 　　 　　随着建筑工业和交通事业的日趋发展，外伤和交通事故越来越多。在众多的损伤中，由于输尿管损伤比较少见，在临床上极易造成误诊而延误治疗。从1985年1月至2006年6月，我们共收治6例，现报告如下： 　　1? 资料与方法　 　　本组6例。男4例，女2例。年龄18～42岁。右侧输尿管破裂4例，左侧2例。致伤原因：撞击伤3例，坠落伤1例，碾压伤2例。损伤部位：肾盂输尿管交界处2例，输尿管中段2例，输尿管下段2例。合并伤：脑挫裂伤1例，脑挫裂伤并骨盆骨折1例，肠破裂并骨盆骨折1例，脾破裂并肾挫伤1例，肝破裂1例，肠系膜破裂并腰4横突骨折1例。6例患者仅有1例表现为镜下血尿，2例表现有少尿。均无肾区疼痛、腰部肌紧张等典型输尿管损