中华普外科手术学杂志(电子版)
中華普外科手術學雜誌(電子版)
중화보외과수술학잡지(전자판)
CHINESE JOURNAL OF OPERATIVE PROCEDURES OF GENERAL SURGERY(ELECTRONIC VERSION)
2014年
2期
112-115
,共4页
直肠肿瘤%手术中并发症%输尿管%创伤和损伤
直腸腫瘤%手術中併髮癥%輸尿管%創傷和損傷
직장종류%수술중병발증%수뇨관%창상화손상
Rectal neoplasms%Intraoperative complications%Ureter%Wounds and injuries
直肠癌是最常见的恶性肿瘤之一,由于直肠与输尿管解剖上的毗邻,直肠癌手术中输尿管损伤不可避免。局部进展期直肠癌侵犯输尿管、术前新辅助放化疗导致盆腔粘连水肿、直肠癌复发需要二次手术,以及外科医生对输尿管解剖不熟悉,术中操作不当均可导致输尿管损伤。术中及时发现,立即修复,预后良好。术后超过48 h发现尿瘘应在保护肾脏功能的同时,2~3个月后再手术修补,留置双J管防止局部狭窄。严格遵守TME原则、在骶生殖襞内侧操作,术前放置双J管等可有效预防输尿管的损伤。
直腸癌是最常見的噁性腫瘤之一,由于直腸與輸尿管解剖上的毗鄰,直腸癌手術中輸尿管損傷不可避免。跼部進展期直腸癌侵犯輸尿管、術前新輔助放化療導緻盆腔粘連水腫、直腸癌複髮需要二次手術,以及外科醫生對輸尿管解剖不熟悉,術中操作不噹均可導緻輸尿管損傷。術中及時髮現,立即脩複,預後良好。術後超過48 h髮現尿瘺應在保護腎髒功能的同時,2~3箇月後再手術脩補,留置雙J管防止跼部狹窄。嚴格遵守TME原則、在骶生殖襞內側操作,術前放置雙J管等可有效預防輸尿管的損傷。
직장암시최상견적악성종류지일,유우직장여수뇨관해부상적비린,직장암수술중수뇨관손상불가피면。국부진전기직장암침범수뇨관、술전신보조방화료도치분강점련수종、직장암복발수요이차수술,이급외과의생대수뇨관해부불숙실,술중조작불당균가도치수뇨관손상。술중급시발현,립즉수복,예후량호。술후초과48 h발현뇨루응재보호신장공능적동시,2~3개월후재수술수보,류치쌍J관방지국부협착。엄격준수TME원칙、재저생식벽내측조작,술전방치쌍J관등가유효예방수뇨관적손상。
Rectal cancer is one of the common malignant tumors .The rectum and mesorectum are very close to the intrapelvic ureter in anatomy .Ureteral injury could often occur during radical resection of rectal carcinoma .The main risk factors of ureteral injury include the invasion of the ureter by locally advanced rectal cancer , the pelvic adhesion and edema after neoadjuvant chemotherapy and the secondary surgeries of recurrence of rectal carcinoma .Iatrogenic ureteral injury often occurred because of the unfamiliar anatomy and misoperation by doctors .If the ureteral injury was found during surgery and was repaired immediately, the prognosis remained good .Urinary fistula found over 48 hours needs to be repaired at 2-3 months after surgery, based on the protection of the kidney ’ s function.Double J stents should be routinely detained for the prevention of local stenosis .Strict compliance of the principles of total mesorectal excision ( TME) , operation close to the medial sacrogenital folds , and preoperative placement of Double J stent could effectively prevent the ureteral injury .