腹腔镜下全子宫切除并发输尿管损伤5例效果剖析.docVIP

腹腔镜下全子宫切除并发输尿管损伤5例效果剖析 　　[摘要] 目的 探讨腹腔镜下全子宫切除并发输尿管损伤的原因及防治。方法 回顾性分析该院2014年1月―2016年1月所收治腹腔镜下全子宫切除并发输尿管损伤的5例病人临床资料。具体包括阴道排液时间、例数及发生原因等。结果 5例在腹腔镜全子宫切除术后才出现不同程度阴道排液（漏尿），2例在术后3 d，2例在术后1周，1例在术后10 d。系在举宫杯的指引下单极电钩环形切开阴道穹窿造成热损伤输尿管膀胱壁内段所致。结论 腹腔镜下全子宫切除并发输尿管损伤主要与手术者的熟练程度、设备条件及手术难度有关。 　　[关键词] 腹腔镜；全子宫；输尿管损伤 　　[中图分类号] R713 [文献标识码] A [文章编号] 1674-0742（2016）10（b）-0075-03 　　[Abstract] Objective To summarize the causes and prevention of laparoscopic total hysterectomy complicated with ureteral injury. Methods Retrospective analysis of the clinical data of 5 patients with ureteral injury in our hospital from January 2014 to January 2016.The time of vaginal discharge， the number of cases and the reasons of the occurrence of the vaginal discharge were included. Results 5 cases in laparoscopic total hysterectomy after the emergence of different degrees of vaginal discharge （leakage）， 2 cases in the three day after the operation， 2 cases in the postoperative week， 1 cases in ten days after surgery. The uterus lifting cup under the guidance of monopolar hook ring incision vaginal fornix heat damage caused by ureteral. Conclusion Laparoscopic total hysterectomy complicated with ureteral injury is mainly related to the proficiency of operator， equipment condition and operation difficulty. The prevention measures： attentions be paid to the ureteral anatomic location； fully separate the bladder outside the cervical mouth； choose energy equipment such as ultrasonic knife to minimalizing electronic damage； checking the ureteral contorts and peristalsis；when meet pelvic adhesion， preoperative placement of ureteral catheter is necessary. 　　[Key words] Laparoscopic； Total hysterectomy； Ureteral injury 　　腹腔镜手术因其创伤小、干扰少、恢复快、痛苦轻等特点，逐渐被广泛应用于妇科疾病的诊治。经过多年的实践积累、器械更新及操作技巧提升，适应症及范围不断更新，腹腔镜手术的有效性与安全性已与开腹手术不相上下，并已成为妇科盆腔良恶性肿瘤治疗的首选术式。由于腹腔镜手术是集光、电、力等于一体，且双手不能直接接着操作部位[1]，腹腔镜全子宫切除是难度最大、操作技术最强的一种术式，如不掌握操作规程和娴熟操作技巧或不熟悉能源的原理，就有可能造成并发症。现对该院2014年1月―2016年1月5年间5例腹腔镜全子宫切除并发输尿管损伤分析，现报道如下。 　　1 资料与方法 　　1.1 一般资料 　　5例患者