Prevention and treatment of ureteral injury after rectal cancer surgery

The ureter is one of the organs most vulnerable to injury during rectal cancer surgery, with the left pelvic segment being the most vulnerable. It is generally believed that this is caused by local infiltration of tumor tissue, heavy bleeding during surgery, and accidental ligation of the ureter during suture to stop bleeding. It can also be caused by unclear exposure of the surgical field, which can lead to accidental injury to the ureter.

To reduce and avoid ureteral injury, the operator must be familiar with the local anatomical structure and adjacent relationships of the ureter during rectal cancer surgery, and perform the operation carefully. Before surgery, the scope of tumor infiltration should be as clear as possible. For patients suspected of tumor invasion of the ureter, pyeloureterography should be performed before surgery to understand the position and changes of the ureter. During surgery, attention should be paid to whether there is urine leakage in the surgical field, whether the ureter draws bloody urine, or whether the ureter is dilated. If ureteral injury is found during surgery, it should be treated in a timely manner, and ureteral end-to-end anastomosis should be performed immediately, and double "J" tubes should be left in place. The patient should recover well after surgery. If urinary fistula is found after surgery, angiography should be performed to confirm the diagnosis and provide treatment.

Small urinary fistulas can usually heal on their own. Large urinary fistulas that cannot heal on their own can be repaired or anastomosed end to end through elective surgery. The anastomosis should be tension-free, and the ends should be cut off and trimmed into an oblique surface. Intermittent eversion sutures can be performed with absorbable sutures and double "J" tubes can be placed.