腹腔镜下宫颈癌根治术致泌尿系统 脏器损伤的原因及预防

The reason and prevention of genitourinary organ secondary to laparoscopic radical hysterectomy in the early cervical cancer

摘要:

目的 探讨腹腔镜下宫颈癌根治术致泌尿系统脏器损伤的原因及预防措施。方法 回顾性分析2006年12月-2011年12月，在该院行腹腔镜下宫颈癌根治术致泌尿系统脏器损伤的14例患者临床资料。结果 所有患者均在腹腔镜下实施手术，主要并发症包括：术中发生膀胱损伤4例，输尿管损伤2例；输尿管阴道瘘7例，其中术后早期输尿管阴道瘘1例，术后出现晚期输尿管阴道瘘6例；输尿管狭窄1例。结论 腹腔镜下宫颈癌根治手术范围大，特别是在腹腔镜开展的初期，对镜下子宫颈周围解剖认识不足，且操作不熟练时容易出现泌尿系统脏器损伤并发症。熟悉局部解剖，提高手术操作技巧，积累手术经验是预防泌尿系损伤的关键。

Abstract:

【Objective】 To evaluate the reason and prevention of genitourinary organ secondary to laparoscopic radical hysterectomy in the early cervical cancer. 【Methods】 The medical records of laparoscopic radical hysterectomy patients in the early cervical cancer between December 2006 and December 2011 were reviewed retrospectively.14 genitourinary injury cases caused by laparoscopic radical hysterectomy were analyzed. 【Results】 All patients were operated on by laparoscopic. Intraoperative and postoperative complications occurred in 14 patients. 4 patients sustained bladder injuries, and 2 patients sustained urethral injuries intraoperatively. Ureterovaginal fistulas were identified in 7 patients postoperatively. Urethral stricture was identified in 1 patient postoperatively. 【Conclusion】 Surgery related complications may usually occur in the initial stage of laparoscopic radical hysterectomy because of a larger surgery range, insufficient laparoscopic anatomical knowledge and unskillful operation. They will be reduced by mastering the local anatomy, improving operation skills and accumulating experience.