Preset Ureter Catheter Of Laparoscopic Radical Hysterectomy Of Cervical Cancer

In recent years, with the development of laparoscopic operation and technologycontinue to improve this technique has been widely used in gynecological operation,compared with the traditional open operation, laparoscopic operation has the advantagesof less trauma, less bleeding, short operation time, rapid postoperative recovery, shorterhospitalization time etc, but also has the blood vessel, ureter, high rate of intestinalinjury disadvantages. This procedure has been accepted by more and more doctors andpatients, especially the increasing hysterectomy and retroperitoneal operation such aspelvic lymphadenectomy, to increase operation difficulty and gynecologic operationquantity, and urinary system injury incidence rate increased. Because of laparoscopichysterectomy in clinical widely carried out, the intraoperative ureteral injury and otherserious complications than abdominal hysterectomy increased significantly. Ureteralinjury caused by gynecological laparoscopic operation mainly occurred in operation,safe and effective operation method using laparoscopic operation is very necessary. Atpresent, the experts and scholars on whether preoperative routine placement of ureteralcatheter as preventive measures to avoid injury to the ureter or controversial.Operation of ureteral injury in pelvic operation is rare but potentially seriouscomplication. If handled properly, will lead to leakage of urine, pelvic infection,obstruction of ureter, and renal function impairment, repair two times operation willbring more damage and economic pressure to the patients. Ureteral injury ingynecological operation caused by accounted for the majority of. Whether because ofbenign uterine myomectomy, endometriotic lesions resection, or diseases such asmalignant cervical cancer, when pelvic stripping operation implementation difficult, theureteral injury risks increased. Laparoscopic extensive total hysterectomy has becomethe ideal surgical treatment for patients with early cervical cancer, but because in cervical cancer radical hysterectomy operation, uterine resection range is wide, the needto open the ureter tunnel, the damage rate of higher. Surgery laparoscopic not directlytouch,"feel" disappear, but also because of laparoscopic operation often byelectrocoagulation and electrocision treating vascular and tissue, in addition tomechanical injury may cause thermal damage, heat damage of ureter are often hard tofind, but after a period of time to ureteral leak, appear the corresponding symptoms andsigns. In addition, in the treatment of uterine artery, due to the need for repeated electriccoagulation, electrocautery, also easy to cause the ureteral thermal damage, causinglocal necrosis. In addition to a laparoscopic radical operation for hysterectomy sodifficult increases ureteral injury risk. Ureteral injuries most often occur in thefollowing5parts: the base of the broad ligament, ureter by uterine vascular below; theuterine vessels, ureter tunnel through the main ligament of the uterus to the front centralinto the bladder; ureter wall internal entering the bladder wall; the infundibulopelvicligament level or below; above the uterosacral ligament walking on the side wall of thebasin, the part of ureter. The majority of ureteral injury in the3.0cm under the ureter,walking between uterine vascular and urinary bladder, the other part in the pot wallinfundibulopelvic ligament region of the ureter.Although the direct visualization of peritoneal cavity after careful explorationtechnology and ureter is probably the best way to avoid injury to the ureter, but somesurgeons recommend preoperative placement of ureteral catheter may help todistinguish the ureter. The surgeons placed ureteral catheter decision is based mainly onsubjective opinion expected difficulty of treatment on specific cases on the. Manyfactors will affect the evaluation, including clinical diagnosis, patients with pelvic massshape, size and past medical history and operation. On the contrary, there are questionsabout whether the preventive ureteral catheterization good gynecologist. Abdominaloperation using ureteral catheter is a contentious area. Agree with the surgeons believedthat preoperative presetting ureteral catheter help intraoperative identification of ureter,and prevention of ureteral injury, and to have a role in the treatment of mild injury ofureter. Others worry that the occurrence of injury and postoperative urinary system mayintubation complications, including oliguria, anuria and urinary tract infection.Moreover, the preoperative ureteral catheter insertion increases the operation time,anesthesia time and total operation cost. Ureteral catheter may be particularly useful in alaparoscopic operation, because this cannot touch position by hand.This research reviews the Dalian maternity hospital in176cases of cervical cancer patients with laparoscopic extensive total hysterectomy to implement preventiveureteral catheterization experience, to evaluate the frequency of use, prevention ofureteral catheterization of the prevention of ureteral injury is effective and relatedcomplications.Objective: To discuss the clinical efficacy of temporary ureteral catheter inpreventing the ureteral iatrogenic damage in cervical cancer undergoing laparoscopicradical hysterectomy.Methods: All the Cases are diagnosed definitely cervical cancer preoperativelybetween December2008and December2012in our hospital and the clinical stagesareⅠ a2-Ⅱ a period. A total of176laparoscopic radical hysterectomy andlymphadenectomy procedures were performed.176cases were divided into two groups.Ureteral catheters were installed using cystoscopy before operation in86patients(groupA),90cases were not placed ureteral catheter (group B). these cases wereretrospectively analyzed with postoperative hospitalization time, intraoperative andpostoperative complications.Results:6cases （3.41%） ureteral injuries happened in all;4cases (4.65%)ureteral injuries happened in group A.these two cases appeared urinary leak in thepostoperative8thday and9thday and10thday and25thday respectively;2cases(2.22%) ureteral injuries happened in group B.1case of intraoperative direct injury andthe other one appear urinary leak in the postoperative21th day. There werestatistically significant differences in operating time, hemorrhage and hematuria(including microscopic hematuria), postoperative urinary tract infection and pain in twogroups (P<0.05).Conclusion：Ureteral catheter that is placed preoperatively helps to identify theureter in laparoscopic radical hysterectomy, but doesn`t decrease the incidence ofureteral injury.