闭合性输尿管破裂6例的诊治体会论文
2015-04-18 01:01
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作者:邓争鸣,高成绩,李庆文,王志峰 【关键词】 ,,输尿
作者:邓争鸣,高成绩,李庆文,王志峰
【关键词】 ,,输尿管破裂;,,影像学诊断;,,外科手术
摘要:目的:探讨闭合性输尿管破裂的临床特征。方法:回顾分析6例闭合性输尿管破裂的临床资料。结果:2例在早期剖腹探查中明确诊断,1例于伤后d2明确诊断,另3例在伤后5~25d才明确诊断。3例早期行一期输尿管或输尿管肾盂端端吻合术,2例于损伤3个月后行尿液性囊肿切除输尿管端端吻合术,1例行单纯尿液引流。随访4个月至5年,均行静脉肾盂造影、B超、血Cr、BUN检查;2例肾轻度积水,1例吻合口轻度狭窄,余3例均正常。结论:尿外渗、肾积水是输尿管破裂的主要表现,大剂量静脉肾盂造影及逆行插管输尿管造影、CT检查对本病的诊断有重要价值。急诊手术探查,争取一期修复有利于提高疗效。
关键词: 输尿管破裂; 影像学诊断; 外科手术
An Experience on 6 Cases Closed Ureteral Rupture
Abstract:Objective:To study the clinical characteristics of closed ureteral ruputure. Method:Review and analysis the clinical datas 6 cases closed ureteral ruputure. Result:2 cases were made definite diagnosis among celiotomy exploratory, 1 case was diagnosed next day after injury, Another 3 cases weren’t made definite diagnosis until 5~25 days later. 3 cases were taken ureter or ureter to renal pelvis end-to-end one-stage anastomosis early,2 cases were taken urinary cyst resection and ureter end-to-end anastomosis three months later,1 case performed extravsation of urine drainage only. The follow-up period ranged from 4 months to 5 years ,All of them were taken intravenous urography(IVU)、B-ultrosonography、blood Cr 、BUN examination ;2 cases were found slight hydronephrosis,1 case was found slight anastomotic stenosis, The other 3 cases are normal. Conclusion: Urinary extravsation、hydronephrosis are the main characteristics of ureteral rupture,The IVU of great dose and retrograde pyelograpgy、CT have important value on ureteral rupture diagnosis. The emergency operation exploratory ,One-stage repair must improve the curative effect .
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Key words: Ureteral rupture; Imaging diagnosis; Surgical operation
随着建筑工业和交通事业的日趋发展,外伤和交通事故越来越多。在众多的损伤中,由于输尿管损伤比较少见,在临床上极易造成误诊而延误治疗。从1985年1月至2006年6月,我们共收治6例,现报告如下:
1 资料与方法
本组6例。男4例,女2例。年龄18~42岁。右侧输尿管破裂4例,左侧2例。致伤原因:撞击伤3例,坠落伤1例,碾压伤2例。损伤部位:肾盂输尿管交界处2例,输尿管中段2例,输尿管下段2例。合并伤:脑挫裂伤1例,脑挫裂伤并骨盆骨折1例,肠破裂并骨盆骨折1例,脾破裂并肾挫伤1例,肝破裂1例,肠系膜破裂并腰4横突骨折1例。6例患者仅有1例表现为镜下血尿,2例表现有少尿。均无肾区疼痛、腰部肌紧张等典型输尿管损伤的表现。1例合并有肠系膜破裂、腰4横突骨折在行肠系膜修补后发现腹膜后有血肿,探查时见为淡血性液体,进一步检查时发现有输尿管中段完全断裂,行输尿管端端吻合;1例合并肝破裂者,在肝修补后发现右侧腹膜后血肿,探查时见血较淡,静脉注射腚固脂5ml后发现渗液呈蓝色而进一步探查见右肾盂输尿管交界处断裂,行一期端端吻合。余4例均延误诊断。其中1例合并脾破裂、左肾挫伤者,在急诊脾切除后发现左侧腹膜后血肿,误认为是肾挫伤引起,未予探查而在腹膜后放置引流。次日发现引流量较多并为淡血性,而且尿量减少,血压脉搏又无明显变化,考虑有输尿管破裂可能,复查B超见肾挫伤较轻,行逆行插管,在导管进入18cm时受阻,造影见第三腰椎平面,有造影剂外溢而肾盂未显影。再次手术发现左侧肾盂输尿管交界处断裂行肾盂输尿管一期吻合;1例合并肠破裂、骨盆骨折者,在行肠修补后发现腹膜后血肿误认为是骨盆骨折出血而未予探查,于术后d5患者出现高热、腹胀,体检发现右侧髂骨上方明显肿胀,B超检查发现肾脏正常,右侧腹膜外及腹膜后有大量积液,穿刺抽出大量尿样液体,行大剂量静脉肾盂造影(IVU)见腰5水平有造影剂外溢,给行腹膜外切开引流;另2例合并有脑挫裂伤者分别在伤后18d、25d出现腰腹部肿物,经B超、大剂量IVU、逆行插管输尿管肾盂造影检查诊断为输尿管破裂,但均已行成尿液性囊肿,于3个月后行囊肿切除后再分别行输尿管端端吻合术。