Objective To investigate the causes and management strategies of ureteral injury associated with laparoscopic radical surgery of rectal cancer.Method A retrospective analysis was conducted on the clinical characteristics,management,and prognosis of ureteral injuries in 2 150 rectal cancer patients who underwent laparoscopic radical surgery at our hospital between January 2018 and January 2023.Results Ureteral injury occurred in 6 patients(4 male and 2 female),with an incidence of 0.28％.The diameter of tumor was larger than 3 cm in 5 cases,and the clinical stage of tumor was Ⅲ in all cases.Among them,two cases of ureteral injury were identified intraoperatively.One case involved accidental clamping with Hem-o-lok clips,which were immediately removed,followed by a D-J stent placement.The other case involved ureteral injury during dissection due to advanced tumor,which was treated with end-to-end ureteral anastomosis and a D-J stent placement.Four patients were diagnosed within one week postoperatively,presenting with a sudden increase in pelvic drainage volume(4 cases)and abnormally elevated creatinine levels in pelvic drainage fluid(4 cases).Among these patients,3 underwent reoperation of surgical repair and D-J stent placement due to 2 cases of complete ureteral transection and 1 case of partial transection.Another case was improved after conservative treatments,such as D-J tube placement,anti-infection therapy,and bladder irrigation.All cases were discharged with the average hospitalization duration of 2 weeks postoperatively.One-year follow-up revealed a good prognosis without ureteral stricture,renal pelvis dilation,or recurrent urinary tract infection.Conclusions Iatrogenic ureteral injury is rare in laparoscopic radical surgery of rectal cancer.Prompt recognition and appropriate management,based on the extent and type of the injury,such as surgical repair and/or D-J stent placement,generally result in a favorable prognosis.
laparoscopic radical resection of rectal cancerureteral injury
万方数据
维普
