婦產科子宮全切除手術時及術後產生之泌尿科之併發症及其後續處理—區域醫院之經驗
許兆畬1、劉錦成2、戴浩平1、陳祥來1、謝肇新1、黃鐘銘1、翁瑋駿1、
黃立華1、李毅彥1、童敏哲1
童綜合醫院 外科部 泌尿外科1 婦產科2
Urologic complications during and after total hysterectomy and subsequent management --
Chao-Yu Hsu1, Kim-Seng Law, Hao-Ping Tai1, Hsiang-Lai Chen1, Siu-San Tse1, Zhon-Min Huang1, Wei-Chun Weng1, Li-Hua Huang1, I-Yen Lee1, Min-Che Tung1
Divisions of Urology1, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology2, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Purpose: To review and discuss the cases underwent total abdominal hysterectomy, lapaparoscopic hysterectomy, robotic hysterectomy or transvaginal hysterectomy retrospectively, who had management and treatment of urologic complications after the above procedures at our hospital.
Materials and Methods: From 2012/1/1 to 2016/6/30, 696 female patients received total abdominal hysterectomy, laparoscopic hysterectomy, robotic hysterectomy or transvaginal hysterectomy at our hospital for variant gynecologic pathologies. 43 cases (6.2%) were performed urologic procedures during or after the operations.
Results: All 43 cases, 41 cases (5.9%) had initial management including cystoscopy, ureteroscopy, endoscopic ureterotomy, ureteral catheterization or double J stenting. Eight more complicated cases (1.1%) had subsequent managements including ureteroneocystostomy, endoscopic dilatation of ureter, cystorrhaphy, ureteroureterotomy or transureteroureterostomy. However, 6 cases had both initial and subsequent management. The mean delayed interval between initial management and gynecologic procedure was 142.67 days (from 0 to 1356 days). The mean delayed interval before subsequent management was 177.38 days (from 0 to 908 days).
Conclusions: The incidence of urologic injuries after total hysterectomy was similar compared with other studies. Thermal spreading、thorough dissection、improper traction and countertraction and improper tissue suture ligation were causes of urologic injuries. Strategy such as performing cystoscopy with intravenous dye material injection is method to shorten time interval of initial or subsequent urologic management.