关键词: 腹腔镜结直肠手术, 输尿管损伤, 尿道损伤, 膜解剖, 肾前筋膜, 十二指肠入路, 降结肠旋转不良

Abstract: Prevention and treatment of ureteral and urethral injuries in laparoscopic colorectal surgery        SUN Ling-yu, BAI Ming-han，ZHENG Hong-qun. Department of Oncology，the Fourth Affiliated Hospital of Harbin Medical University，Harbin 150000，China
Corresponding author:SUN Ling-yu, E-mail:lingyu5758@163.com
Abstract    Ureteral and urethral injuries during laparoscopic surgery for colorectal cancer should not be ignored. Double-J catheter should be placed before operation for patients with ureterectasis, hydronephrosis, locally advanced tumor, neoadjuvant radiotherapy and chemotherapy, and tumor recurrence requiring reoperation. To prevent ureteral injury effectively during abdominal operation, clinicians should know the ureter-related colorectal membrane anatomy well, meticulously separate in the correct fascia plane to ensure the integrity of the prerenal fascia. Ureteral injuries found during or early after operation should be repaired and reconstructed in time, and those found late after operation need secondary surgery. To prevent urethra injury during perineal operation, clinicians should know urethra-related pelvic floor anatomy, identify the anatomical landmarks , such as rectourethral muscle and Hiatal ligament, and operate according to the principle of “from easy to difficult”. Urethral repair or end to end urethrostomy can be performed if urethral injury is found during operation. Cystostomy and urethral traction should be performed if urethral injury is found late after operation.

Key words: laparoscopic colorectal surgery, ureteral injury, urethral injury, membrane anatomy, prerenal fascia, duodenal guided approach, persistent desending mesocolon