婦產科及大腸直腸外科手術關於膀胱輸尿管醫源性創傷之探討
鄭隆峯1、袁倫祥1、余家政1,2,3
1高雄榮民總醫院外科部泌尿外科
2國防醫學中心三軍總醫院外科部泌尿外科
3大仁科技大學藥學系
Iatrogenic trauma of ureter and u-bladder during GYN and CRS operation
Lung-Feng Cheng1、Lun-hsiang Yuan 1、Chia-Cheng Yu1,2,3
1 Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
2 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
3 Department of Pharmacy, Tajen University
Purpose: According to EAU Guidelines on Iatrogenic Trauma, ureter and u-bladder were thought most injured by medical procedures. Organs near ureter and u-bladder: colon, female genital organ. We want to evaluate non-urologic (CRS/GYN) ureter & bladder injury incidence and stratify risk groups and evaluate prognosis.
Materials and Methods: We collect the patients who suffered from iatrogenic trauma of urinary tract in VGHKS (Kaohsiung Veterans General Hospital) from 2005 to 2015 via medical chart. We retrospectively reviewed chart about CRS , GYN, ureter injury and bladder injury. Outcome was defined urinary condition post-operation one year.
Results: Total 70 patients were noted, respectively 20 ureteral injury and 50 bladder injury. During ureteral injury, 8 in GYN, 12 in CRS surgery, 3 CRS and 1 GYN patients were delayed diagnosed. Poor outcome: One CRS patient needed permanent PCN and one GYN patient was expired. During bladder injury, 40 in GYN, 10 in CRS surgery, all diagnosed intra-operation. Poor Outcome: 1 ileal conduit for persisted urine leakage.
Conclusions: Bladder injury occurred very frequently as opposed to ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injury. Early diagnosis and early urologic intervention are necessary to prevent the occurrence of delayed urologic complications.