带蒂大网膜移植修补复杂性膀胱阴道瘘67例报告  

Pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas (report of 67 cases)

作　　者：乜国雁[1] 

机构地区：[1]青海省人民医院泌尿外科,西宁810007

出　　处：《中华泌尿外科杂志》2006年第2期118-120,共3页Chinese Journal of Urology

摘　　要：目的探讨带蒂大网膜移植修补复杂性膀胱阴道瘘的临床疗效。方法复杂性膀胱阴道瘘67例,年龄19～38岁,平均24岁,病程6个月～11年,平均3.5年。均为产伤导致,瘘口最大径2.5～4.5cm,平均3.0cm。合并输尿管阴道瘘15例(左侧5例,右侧7例,双侧3例),输尿管开口狭窄4例(左侧2例,右侧1例,双侧1例);肾盂积水17例(左侧7例,右侧9例,双侧1例),膀胱结石9例。均采用移植带蒂大网膜覆盖于膀胱和阴道瘘口修补后的创口之间,形成具有保护层等作用的牢靠“屏障”。结果67例手术一次成功63例,成功率94%。其中2例术后出现0.2～0.4cm小漏尿口,延长留置导尿管时间等处理后治愈。手术失败4例(6%),行输尿管膀胱再植21例。术后出现轻度尿失禁29例(46%),经对症处理后治愈21例。63例随访3个月,尿瘘无复发,轻度尿失禁8例,B超及IVU复查肾盂轻度积水3例。结论带蒂大网膜移植修补复杂性膀胱阴道瘘,手术成功率高,同时还可处理输尿管开口狭窄、瘘等并发症。Objective To investigate the therapeutic effects of pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas. Methods This series included 67 cases of complex vesicovaginal fistulas. Their mean age was 24 years （range, 19 -38 years）. The disease course ranged from 6 months to 11 years （ mean, 3.5 years）. All the fistulas resulted from dystocia. The fistula outlet was 2.5 - 4.5 cm in greatest dimension with a mean of 3.0 cm. The complications included ureter vesicovaginal fistulas in 15 cases （ left side in 5 ,right in 7 and both in 3 ） ,ureter orifice stricture in 4 cases （ left side in 2 ,right in 1 and both in 1） ,hydronephrosis in 17 cases （left side in 7, right in 9 and both in 1 ） ,bladder calculi in 9 cases. The pedieled greater omentum displacement was performed to form a kind of protective ＂ tightening screen＂, which covered the wound repaired between bladder and vesicovaginal fistula. Results The procedure was successfully completed at a single session of repair in 63 patients with a success rate of 94%. Two patients underwent further prolonged indwelling catheterization because of tiny vesicovaginal fistulas of 0. 2 - 0. 4 cm after initial operation. The procedure failed in 4 cases （6%）. Among the 67 patients,ureterovesicoplasty was pedormed in 21 cases. After operation,29 patients （46%） had mild incontinence; of them 21 got successful further treatment. The follow-up was 3 months in the 63 cases with successful results. No vesicovaginal fistula occurred. However,8 cases had mild incontinence,and B-ultrasound and IVU showed mild hydronephrosis in 3 cases. Conclusions The operation by ＂tightening screen＂ to repair vesicovaginal fistulas through pedieled greater omentum displacement can improve the success rate of operation and allow the appropriate treatment of complications such as ureter orifice stenosis and fistulas.

关 键 词：膀胱阴道瘘 大网膜 修补 尿失禁 带蒂大网膜移植 

分 类 号：R699[医药卫生—泌尿科学]