第二节输尿管损伤（Second ureteral injuries）.docVIP

第二节输尿管损伤（Second ureteral injuries） Second ureteral injuries The ureter is located in the retroperitoneal space and is well protected by surrounding tissues and has a considerable range of motion. Therefore, ureteral injuries caused by external violence are rare, mostly iatrogenic injuries. After injury, it is easy to be neglected, and most of them are found when symptoms occur, delaying diagnosis and treatment. Pathogeny 1. open surgery injury often occurs in the pelvic and retroperitoneal extensive anatomical surgery such as colon, rectum, uterine resection and vascular surgery, because the anatomy is complicated, the surgical field is not clear, in a hurry to stop bleeding, large jaws, ureteral ligation induced injury; tumor of ureter moved retroperitoneal fibrosis or adhesions, will make the operation is difficult, easy to injure. During the operation, it is not necessary to find the injury. 2. cavity equipment damage by bladder endoscopic retrograde ureteral catheterization, expansion, stone, brush biopsy, ureteroscopy, ureteral injury (broken) stone and other operations can be. When the ureter is narrow, twisted, stuck or inflamed, it may occur that the ureter is torn or even pulled apart. Be sure to handle it carefully. 3. radiation injury in cervical cancer and prostate cancer after radiotherapy, the ureteral wall edema, hemorrhage, necrosis and scar formation of urinary Da or fibrous tissue formation, caused by ureteral obstruction. 4. trauma outside violence caused by ureteral injury was more common in gun injuries, occasionally needlestick injuries and traffic accidents, falls from a height caused by ureteral tear, often accompanied by large blood vessels or abdominal injury. The pathological changes vary according to the type of injury and the time to be treated. There may be contusion, perforation, ligation, clamping, cutting or cutting, tearing, twisting, adventitia peeling, ischemia and necrosis, etc.. The slight contusion of the ureter can cure itself