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妇科手术中泌尿道损伤的预防

Author
Donna Gilmour, MD, FRCSC
Section Editors
Linda Brubaker, MD, FACOG
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
杨兴升, 主任医师，教授

引言

女性生殖道和泌尿道在解剖学及胚胎学上的关系都非常密切[1]。掌握其解剖关系对预防妇科手术时的泌尿道损伤有重要作用。主要预防方法是仔细进行手术分离并熟知手术野中泌尿道结构的位置。

本文将总结妇科手术(主要是子宫切除术)中泌尿道损伤的预防。妇科手术中泌尿道损伤的评估和处理、高级操作(针对尿失禁、盆腔脏器脱垂或妇科恶性肿瘤)中的泌尿道损伤以及产科手术中的泌尿道损伤都将单独讨论。 (参见“妇科手术中的尿路损伤：评估和处理”和“根治性子宫切除术”和“Cesarean delivery: Surgical technique”和“Operative vaginal delivery”)

发生率

女性盆腔手术中泌尿道损伤的总体发生率约为1%[2]。膀胱损伤比输尿管损伤更为常见[1]。然而，准确的发生率难以确定。报道中的损伤发生率不一致，差别主要取决于损伤的诊断手段和手术类型；其他因素包括患者特征及研究设计。

膀胱镜诊断的损伤 — 在手术操作后立即常规行膀胱镜检查的研究中，泌尿道损伤的发生率显著高于其他诊断方法得到的结果(通常为术中用肉眼检查)。一项纳入47项回顾性研究的系统评价和后来有关良性妇科手术泌尿道损伤的两项前瞻性研究都证明了该观点[1,3,4]。在子宫切除术方面，常规行膀胱镜的研究与使用其他诊断手段的研究相比，输尿管损伤率(15-18/1000例操作 vs 0.2-7/1000例操作)及膀胱损伤率(17-29/1000例操作 vs 0.3 to 6/1000例操作)都较高。

这些发现说明，如果术后未能立即常规行膀胱镜检查，将会低估泌尿道损伤率。真实的损伤率可能更高，因为膀胱镜并不能发现所有损伤，尤其是部分输尿管梗阻或断裂[1,5]。另一方面，有些经膀胱镜发现的损伤可能无症状和/或自愈[1,6,7]。膀胱镜在诊断手术泌尿道损伤中的临床应用将单独讨论。 (参见“妇科手术中的尿路损伤：评估和处理”，关于‘膀胱镜检查’一节)

                           

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-19.
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