本组6例直肠癌手术发生尿路损伤占同期直肠癌手术的1.8%,其中男4例,女2例,年龄24~72岁,平均47岁,就其损伤原因进行分析,除2例因肿瘤巨大并对尿路造成浸润,因此手术时发生相应的损伤是难以避免的,而另4例均有不同程度的存在着操作上失误。直肠癌手术所致的尿路损伤以输尿管损伤发生率最高,本组6例就有5例。输尿管损伤要力争在手术中发现,及时处理。这对降低并发症是十分重要的,但手术中输尿管损伤没有特异征象,是“安静的”,稍不警惕就被忽略,即使术后也往往诊断困难,主要依靠医师认真仔细观察、判断、一旦有异常,应及时地作相应检查,尽早确诊。术中发现输尿管损伤应行端端吻合,但吻合口质量至关重要,因而要求:吻合口大而无张力;断端血供良好;粘膜对粘膜而无扭曲;内置支撑管;吻合口旁放置引流。对于输尿管下端损伤,下段缺损者,可行输尿管膀胱吻合,或行膀胱瓣管术,或输尿管膀胱再植术等。输尿管损伤重点在于预防,对术者应要求:熟悉解剖;了解输尿管易损伤的部位,因此在分离、钳夹、切断时应特别注意;操作仔细,显露输尿管后,加以保护;游离输尿管不易过长,特别是外膜剥离,以免影响其血供;作Miles手术时,会阴组不宜过度牵拉组织,以免将输尿管和膀胱拉向会阴部而误伤;对难度大的,术前应先行输尿管插管,以便术中 This group of 6 cases of rectal cancer surgery urinary tract injury accounted for 1.8% of rectal cancer surgery, including 4 males and 2 females, aged 24 to 72 years, an average of 47 years old, analysis of the causes of its damage, except 2 cases The tumor is huge and causes infiltration of the urinary tract, so it is difficult to avoid the corresponding injury during surgery, and the other 4 cases have varying degrees of operational errors. Urinary tract injury caused by rectal cancer surgery has the highest incidence of ureteral injury. There were 5 cases in 6 cases in this group. Urinary injury should strive to be discovered during surgery and be treated in time. This is very important to reduce complications, but there are no specific signs of ureteral injury during surgery. It is “quiet”. It is ignored if it is not vigilant. Even if it is difficult to diagnose after surgery, it depends mainly on the doctor’s careful observation and judgment. Abnormalities should be checked in a timely manner to confirm the diagnosis as soon as possible. Intraoperative ureteral injury should be found at the end of the anastomosis, but the quality of the anastomosis is critical, requiring: large anastomosis without tension; good blood supply to the broken end; mucosa without distortion on the mucous membrane; built-in support tube; placed next to the anastomosis drainage. For the lower ureteral injury, the lower part of the defect, ureteral ureteral anastomosis, or bladder valve, or ureterocystectomy. Ureteral injury is mainly focused on prevention. For the operator, he should be familiar with the anatomy and understand the site of ureteral injury. Therefore, special attention should be paid to separation, clamping, and cutting. Careful operation should be performed after the ureter is exposed. The free ureter should not be too long. , especially the outer membrane peeling, so as not to affect its blood supply; when Miles operation, the perineal group should not over-pull the tissue, so as not to pull the ureter and bladder to the perineum and accidental injury; for difficult, preoperative ureteral catheterization For intraoperative