Abstract：Objective: To investigate the safety and efficacy of ureteroscope and laparoscopic surgery for the treatment of ureteral injury caused by a gynecological operation. Methods: In the study, 33 cases of ureteral injury in gynecologic operation, with mean age being 45 (20 to 69) years. 5 cases of ureteral injuries were found during the operation and immediate laparoscopic-aided D-J stent insertion was done through ureteral lesion. Repair and suture or end to end anastomosis of ureter was followed. Delayed ureteral injury was found in 28 cases, including 1 case of solitary kidney patients. In this case, abnormal drainage fluid was found 8 hours after operation, the partial lesion of the lower ureter were examined by ureteroscopy, and D-J stent insertion and laparoscopic repair were done. Vaginal stump leakage was found 7 to 35 days after operation in the rest 27 cases. Then cystoscopic-aided or ureteroscopic-aided D-J stent insertion succeeded in 16 cases, and the D-J stent retained for 3 to 2 months. Laparoscopic exploration was done in the other 11 cases of patients with D-J stent insertion failure. Low lesion location, Direct insertion of ureter and bladder was done in the cases of low lesion location. If lesion location was high, free cutting of bladder wall flap and synthesis of tubular in order we do ureteroneocystostomy by free cutting of bladder wall flap and the synthesis of tubular. Results: One of the 16 patients who did successfully D-J stent insertion had long term urinary fistula. This patient recovered after undergoing laparoscopic surgery successfully after 3 months. The 11 cases of patients with D-J stent insertion failure were also healed after one-stage laparoscopic repair. In these cases, operating time was 110-160 min (mean,132 min); ostoperative hospitalization was 5 to 8 days (mean, 6 days); retention catheterization time was 3 to 4 weeks. We removed D-J stent under the cystoscope 4 to 8 weeks after operation. B-us were carried out 3 to 6 months after operation, and mild hydronephrosis was seen in all cases. Conclusions: Ureteral injury caused by gynecological surgery can be cured by inserting the D-J stent. If the conservative treatment failed, patients can be treated by laparoscopy. Although some challenges existed, there are the advantages of safe and effective, less trauma, less scar and faster postoperative recover. And laparoscopy operation can reduce the psychological burden of patients, to avoid the occurrence of medical disputes.
李茂林,卓栋,章静,王治国,敖平. 微创技术治疗妇科手术后输尿管损伤(附33例报告)[J]. 微创泌尿外科杂志, 2017, 6(2): 85-88.
Li Maolin, Zhuo Dong, Zhang Jing, Wang Zhiguo, Ao Ping. Minimally invasive technique in the treatment of ureteral injury after the gynecologic surgery (A report of 33 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2017, 6(2): 85-88.
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