泌尿系损伤输尿管课件.pptVIP

Section Ⅱ Ureteral Trauma Ureter is the least commonly injured portion of the genitourinary tract , because of its small caliber and mobility and because it is well protected NOTE: caliber【医】管径；口径 Cause The cause of ureteral injury may be categorized as due to external trauma or to iatrogenic events. External trauma Isolated ureteral injuries from external trauma are exceedingly rare. Injury from small-caliber missiles or stab wounds are the usual causes of penetrating ureteral trauma. NOTE: exceedingly【标】ad. 非常地; 极度地; caliber【医】管径；口径; missile【医】投射器; avulsion【医】撕脱伤 Iatrogenic events Iatrogenic ureteral injuries predominate in most civilian and rural population. NOTE: vulnerable【医】易损的;脆弱的； iatrogenic【标】a. 医源性的 The surgical sub specialties and the associated open pelvic procedures most likely to produce iatrogenic ureteral injury are as follows: Gynecology--hysterectomy, oophorectomy, bladder neck suspension; General surgery--colectomy, appendectomy; Vascular surgery--aortoiliac bypass; Urology--ureterolithotomy, ureteral reimplantation. Lumbar laminectomy is an infrequent cause of ureteral injury. The increasing array of pelvic endoscope and laparoscopic procedures is associated with a new group of ureteral injuries, as follows: Gynecology --laser treatment of endometriosis, tubal ligation; Urology-- pelvic lymphadenectomy, ureteroscopy, stone removal; General surgery--appendectomy, bowel resection. Devascularization may occur with extensive pelvic lymph node dissections or after radiation therapy to the pelvis for pelvic cancer. In this situations, ureteral fibrosis and subsequent strictures formation may developed along with ureteral fistulas. NOTE: Devascularization【医】血行阻断 Pathogenesis and pathology Sepsis and severe renal damage，renal atrophy A partially divided ureter urinary extravasation a large urinoma ureterovaginal or ureterocutaneous fistula Intraperitoneal extravasation of urine ileus and per