腹腔镜妇科手术8例泌尿系并发症诊治体会.docVIP

腹腔镜妇科手术8例泌尿系并发症诊治体会[摘要]目的 探讨腹腔镜妇科手术泌尿系并发症的发生原因和治疗。方法 对2002年4月～2008年2月腹腔镜妇科手术泌尿系并发症患者8例进行回顾性分析。结果 1例膀胱损伤及1例输尿管损伤术中转开放术治愈；1例膀胱损伤及1例输尿管损伤经术中镜下缝合伤口治愈；1例膀胱损伤经留置尿管保守治疗治愈；2例尿潴留均经保守治疗治愈；1例输尿管损伤经术后行输尿管膀胱再植术治愈。结论 熟练的操作技术和严格掌握手术适应证，术中注意一些技巧操作的改进是预防减少泌尿系并发症的关键。 [关键词]腹腔镜；妇科手术；泌尿系并发症 [中图分类号] R713[文献标识码] A[文章编号] 1673-9701（2009）12-60-02 Ureteral Complications during Laparoscopic Gynecological Surgery ZHU Dongju Department of Gynaecology and Obstetrics，Nanyang First People’s Hospital，Henan 473000 [Abstract] ObjectiveTo investigate the etiology and prevention and cure of urinary complication during laparoscopic gynecological surgery. Methods A clinical analysis was carried out in 8 cases with complications during laparoscopic gynecological surgery from April 2002 to February 2008. Results One case with bladder injury and one case with ureteral injury recoveried after open operation，one case with bladder injury and one case with ureteral injury were cured through laparoscopic gynecological surgery，one case with bladder injury and two cases with uroschesis were cured after expectant treatment，one case with ureteral injury recoveried after being treated with ureteroneocystostomy. Conclusion The skilled operation and the strict grasp of indication and the improvement of the operational techniques is the key to preventing and reducing Urinary complication [Key Words] Laparoscope；Gynecological surgery；Urinary complication 笔者于2000年4月～2008年2月对986例妇科患者进行腹腔镜下手术治疗，发生泌尿系并发症8例，现报道如下。 1 资料与方法 1.1一般资料 本组8例患者年龄23~50（平均34.2）岁。其中子宫肌瘤5例，子宫内膜异位症2例，输卵管异位妊娠1例；已婚7例，未婚1例；有盆腔手术史2例。 1.2麻醉选择 全部手术均施行气管插管全麻。 1.3镜下手术类型 腹腔镜下子宫全切术3例，腹腔镜下子宫肌瘤剔除术2例，腹腔镜下子宫内膜异位囊肿剥除术2例，腹腔镜下输卵管妊娠保守性手术1例。 1.4方法 对8例发生泌尿系并发症患者进行回顾性分析。 2 结果 腹腔镜下子宫全切术并发膀胱损伤、输尿管损伤、急性尿潴留各1例，腹腔镜下子宫肌瘤剔除术并发膀胱损伤、急性尿潴留各1例，子宫肌瘤剔除术并发膀胱损伤、急性尿潴留各1例。腹腔镜下输卵管妊娠保守性手术并发输尿管损伤1例。1例膀胱损伤及1例输尿管损伤术中转开放术治愈；1例膀胱损伤及1例输尿管损伤经术中镜下缝合伤口治愈；1例膀胱损伤经留置尿管保守治疗治愈；2例尿潴留均经保守治疗治愈；1例输尿管损伤经术后行输尿管膀胱再植术治愈。 3讨论 随着腹腔镜技术的发展，越来越多的妇科疾病通过腹腔镜下微创技术