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输尿管阴道瘘是盆腔手术的一种并发病,早期输尿管膀胱再吻合术效果满意.现将我们收治的8例报告如下.1 临床资料本组病例均经静脉肾盂造影及尿染色检查确诊.其中右侧输尿管损伤4例,左侧3例,双侧1例.年龄38～48岁,平均42.6岁.均发生于妇科手术.经腹子宫肌瘤全切术6例,子宫颈癌全切除术1例,剖宫产术1例.3例有泌尿系症状及发热、腰痛.术后3～30天,平均13.4天发生尿瘘.静脉肾盂造影检查显示患侧输尿管、肾盂、肾盏积水4例,双侧1例,肾不显影3例.逆行输尿管肾盂造影置入输尿管导管1～4cm受阻.8例尿染色检查均为阳性(方法见讨论).8例中1例施行膀胱外疤痕松解,输尿管吻合失败后再次施行膀胱输尿管重新吻合痊愈.其余7例均行输尿管膀胱再吻合.8例病人随访6个月～20年经静脉肾盂造影证实上尿路正常.临床资料见附表.2 讨论盆腔手术时输尿管损伤即使熟练的手术医生也偶
Vaginal fistula is a concurrent pelvic surgery, ureteral reoperation early ureteral satisfaction is satisfactory. We now report the treatment of 8 cases are as follows.1 Clinical data of this group of patients were confirmed by intravenous pyelography and urinalysis, of which right 4 cases of lateral ureteral injury, 3 cases of left and 1 case of bilateral 1. Aged 38 to 48 years old, average 42.6 years old .All occurred in gynecological surgery. Transabdominal myomectomy in 6 cases, total resection of cervical cancer 1 Cases, cesarean section in 1 case .3 cases of urinary symptoms and fever, low back pain .Postoperative 3 to 30 days, an average of 13.4 days of urinary fistula.Verectal pyelography showed ipsilateral ureter, renal pelvis, calyceal hydronephrosis in 4 cases , Bilateral in 1 case, and renal non-visualization in 3. Retroperitoneal ureteroscopy was blocked by ureteral catheter 1 ~ 4cm, and 8 cases were positive for urine staining (see discussion) .One of the 8 cases had extracapsular scar release , Ureteral anastomosis again after the implementation of the ureter re-ureter healed the remaining 7 patients underwent ureter and bladder anastomosis .8 patients were followed up for 6 months to 20 years by intravenous pyelography confirmed upper urinary tract. Discussion of pelvic surgery when ureteral injury even skilled surgery The doctor is even