凶险性前置胎盘输尿管损伤治疗策略分析

doi:10.3877/cma.j.issn.1674-3253.2025.06.011

目的

探讨凶险性前置胎盘（PPP）伴胎盘植入术后输尿管损伤的诊治策略，重点分析术前输尿管逆行置管的作用与局限性，以及多学科协作模式的临床价值。

方法

回顾性分析中山大学附属第三医院2024年5月收治的1例PPP合并胎盘植入患者术中发生输尿管损伤的临床资料，结合文献对比术前预置输尿管导管与未置管患者的输尿管损伤发生率，并总结术中输尿管损伤预防方法及术后输尿管成形术的规范化操作流程。

结果

PPP患者术前置管虽降低损伤风险，但术野出血仍导致误扎造成输尿管损伤。患者术后3个月行输尿管再植术，恢复良好。

结论

凶险性前置胎盘术后输尿管损伤是严重的并发症，术前预置输尿管导管、术中谨慎操作及术后及时处理是减少输尿管损伤的关键。对于复杂病例，多学科协作和个体化手术方案的选择尤为重要。

关键词: 输尿管损伤, 凶险性前置胎盘, 多学科协作, 预置导管, 输尿管再植术

Objective

To explore the diagnosis and treatment strategies for ureteral injury after pernicious placenta previa (PPP) with placental implantation, with a focus on analyzing the role and limitations of preoperative retrograde ureteral catheterization, as well as the clinical value of multidisciplinary collaboration.

Methods

A retrospective analysis was conducted on the clinical data of a patient with PPP combined with placental implantation who was admitted to the Third Affiliated Hospital of Sun Yat-sen University in May 2024. The incidence of ureteral injury during surgery was compared between patients with preplaced ureteral catheters and those without catheters, and the prevention methods of urinary tract injury during surgery and the standardized operation process of postoperative ureteroscopy were summarized.

Results

Although preoperative catheterization reduces the risk of injury in PPP patients, intraoperative bleeding still leads to ureteral injury caused by accidental ligation. The patient underwent ureteral reimplantation 3 months after surgery and recovered well.

Conclusion

Ureteral injury after dangerous placenta previa surgery is a serious complication. Preoperative placement of ureteral catheter, careful operation during surgery, and timely postoperative management are key factors in reducing ureteral injury. For complex cases, multidisciplinary collaboration and the selection of individualized surgical plans are particularly important.

Key words: Ureteral injury, Pernicious placenta previa (PPP), Multidisciplinary collaboration, Preplaced catheters, Ureteral reimplantation

图1 前置胎盘患者术前MR提示子宫下段胎盘植入且侵犯膀胱前壁

图2 前置胎盘患者术后影像资料提示左侧输尿管下段损伤注：a为腹部平片提示左侧输尿管双J管下段缝扎，b为CT检查提示左侧肾包膜下积液

图3 前置胎盘患者输尿管成形术术中及术后复查影像资料注：a为术中发现左侧输尿管扩张下方的缝扎线，b为输尿管膀胱再植术后输尿管扩张缓解，c为术后复查KUB左侧双J管位置良好，下段无迂曲

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Analysis of therapeutic strategies for ureteral injury in pernicious placenta previa

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Analysis of therapeutic strategies for ureteral injury in pernicious placenta previa