의인성 요관손상: 언제, 어떻게 치료할 것인가? (Iatrogenic Ureteral Injury: When and How to Treat?)

서지정보

· 발행기관 : 대한외상학회
· 수록지 정보 : 대한외상학회지 / 21권 / 1호 / 8 ~ 14페이지
· 저자명 : 이종복, 서강일

초록

Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries.
The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of
ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively
should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms
of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or
weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing
opinions on whether an initial conservative or immediate operative intervention is the best line of action.
Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many
authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too
dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end
anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an
end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining
distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral
reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral
injury may be associated with serious complications, so prompt recognition of ureteral injuries is important.
Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased
awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to
decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best
prevention. (J Korean Soc Traumatol 2008;21:8-14)

영어초록

Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries.
The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of
ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively
should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms
of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or
weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing
opinions on whether an initial conservative or immediate operative intervention is the best line of action.
Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many
authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too
dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end
anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an
end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining
distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral
reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral
injury may be associated with serious complications, so prompt recognition of ureteral injuries is important.
Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased
awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to
decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best
prevention. (J Korean Soc Traumatol 2008;21:8-14)

참고자료

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