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요관경시술 후 발생한 중증의 의인성 요관결출

Severe Iatrogenic Ureteral Avulsions Caused by the Ureteroscopic Procedures

대한비뇨기과학회지 2007년 48권 10호 p.1035 ~ 1039
KMID : 0358320070480101035
서은주 ( Seo Eun-Ju ) - 광주기독병원 비뇨기과

강택원 ( Kang Taek-Won ) - 전남대학교 의과대학 비뇨기과학교실
노준화 ( Noh Joon-Hwa ) - 광주기독병원 비뇨기과

Abstract

요관손상은 과거 외상이 주된 원인이었으나 복강이나 골반강 내 수술로, 최근에는 복강경시술이나 내비뇨기과시술 중 발생하는 의인성 손상으로 변화하는 추세이다. 많은 저자들이 골반강 내 수술이나 복강경시술 도중 발생하는 요관손상을 포함한 다양한 합병증을 보고하고 있다. 하지만, 내비뇨기과시술 중 발생한 의인성 요관손상, 특히 비뇨기과에서 흔하게 시행되는 요관경시술 중 발생한 중증의 의인성 요관손상에 대한 체계적인 보고는 없다. 이에 중증의 의인성 요관손상의 발생 빈도, 원인, 특성, 치료 및 예후 등
에 대해 조사하였다.

Purpose:We reviewed the incidence, causes, location, treatment and prognosis of the severe iatrogenic ureteral avulsions caused by ureteroscopy procedures.

Materials and methods: We analyzed the records of eight patients with ureteral avulsion out of 683 patients treated with ureteroscopic procedures, retrospectively. The patients had surgical correction or ureteral double-J stenting for the iatrogenic ureteral avulsions.

Results:The incidence of ureteral avulsion was 1.17%. While seven cases occurred during ureteroscopic removal of a stone, five cases among them occurred during stone basketing and two cases occurred during insertion of the ureteroscope. Another case among eight avulsion cases occurred while removing the during an endopyelotomy for a ureteral stricture. Depending on the length of the ureteral avulsion, four cases were over 2cm, the patientsopen surgical repair for ureteral continuity restoration immediately; three cases, under 2cm, were treated with indwelling ureteral double J stents, and one case with an injury to the entire ureter was treated with a nephrectomy. The result of the surgical treatment as the initial treatment was good in all cases. On the other hand, among the three cases with an inserted ureteral double-J stent, one case had aresult and the other two developed hydronephrosis.

Conclusions:Careful attention to surgical techniques and awareness of risk factors and types of potential injuries are essential to reduce severe iatrogenic ureteral avulsions. Our reports suggest that open surgical repair is better than an indwelling ureteral double-J stent for patients with a ureteral avulsion. (Korean J Urol 2007;48:1035-1039)
KeyWords

Iatrogenic, Ureter, Avulsion, Ureteroscopy
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학술진흥재단(KCI) KoreaMed 대한의학회 회원