女性尿路生殖道瘘诊疗分析(附27例报告)  

Diagnosis and treatment of genitourinary fistulae(Report of 27 cases)

作　　者：刘佛林[1,2] 肖日海[1,2] 邹晓峰[1,2] 袁源湖[1,2] 张国玺[1,2] 伍耿青[1,2] 王晓宁[1,2] 吴玉婷[1,2] 龙大治[1,2] 薛义军[1,2] 徐辉[1,2] 杨军[1,2] 廖云峰[1,2] 钟辛[1,2] 江波[1,2] 徐瑞权[1,2] 刘全亮[1,2] 

机构地区：[1]赣南医学院第一附属医院泌尿外科 [2]赣南医学院泌尿外科研究所,江西赣州341000

出　　处：《临床泌尿外科杂志》2014年第3期253-256,共4页Journal of Clinical Urology

基　　金：江西省"赣鄱英才555工程"领军人才培养计划项目

摘　　要：目的：总结女性尿路生殖道瘘临床诊疗经验，探讨复杂性女性尿路生殖道瘘的治疗方法。方法：本组27例，年龄16～56岁，平均41.2岁。其中膀胱阴道瘘9例，输尿管阴道瘘15例，输尿管子宫瘘1例，尿道阴道瘘2例。妇科盆腔手术所致23例，会阴部或盆腔外伤所致3例，放疗所致1例。9例膀胱阴道瘘中，3例行耻骨上经膀胱修补，2例经阴道修补，3例复杂性瘘经腹修补并移植带蒂大网膜，1例放疗后复杂性瘘行输尿管皮肤造口术。15例输尿管阴道瘘中，6例行输尿管镜下输尿管双J管留置术，9例行输尿管膀胱再植术。1例输尿管子宫瘘行耻骨上辅助经脐单孔腹腔镜（SA_LESS）输尿管膀胱再植术。2例尿道阴遭瘘均经阴道行修补术，其中1例采用改进三层错位缝合术修补。结果：24例一次治愈，成功率为88．89％（24／27）；3例二次手术治愈。平均手术时间75（45～135）min，平均术中出血量60（15～150）ml。术后随访4个月～13年，27例患者均未再出现漏尿，无尿失禁、尿道及阴道狭窄，无继发性肾功能损害。绪论：女性尿路生殖道瘘修补手术方法因人因病而定。术前充分准备，选择恰当的手术修补时机、正确的手术修补途径、术中精细操作是提高尿路生殖道瘘手术成功的关键。对复杂性尿瘘，可采用改进三层错位缝合术、辅助带蒂瓣片或网膜技术修补瘘口，促进愈合。Objective：To summarize the diagnosis and treatment experience of genitourinary fistulae, and to explore therapy method of complicated genitourinary fistulae. Method.. A total of 27 women cases included this study, aged 16 to 56 years old （mean age, 41.2）. We found vesicovaginal fistula （VVF） in nine cases, ureterovaginal fistula in 15 cases, ureterouterine fistula in one case, urethrovaginal fistula in two cases. Gynecological surgery caused 23 cases. Perineal or pelvic trauma caused three cases. The rest one case was caused by radiotherapy. For VVF cases, three of them underwent suprapuhic repair~ two of them underwent transvaginal repair~ three cases of complex vesicovaginal fistulae underwent transabdominal repair and transplantation of pedicled omentum~ the rest one case of complex vesicovaginal fistulas after radiotherapy underwent ureter skin ostomy. For ureterovaginal fis- tula, six cases underwent ureteral double-J tube indwelling surgery~ nine cases underwent ureterovesical reimplan- tation. One case of ureterouterine fistula underwent suprapubic-assisted laparoendoscopic single-site surgery （SA- LESS） of ureterovesical reimplantation. Two cases of urethrovaginal fistula received ransvaginal repair, including a modified three -layer misplaced suture repair for one case. Result： Twenty-four cases were cured by one-stage, and secondary surgeries of three cases were successful. Curative success rate was 88.89~ （24/27）. The average operation time was 75 （range, 45-135） rain. The average blood loss was 60 （range, 15-150） ml. No urine leak- age, incontinence, urethral and vaginal stenosis or secondary renal damage were found in 27 patients after follow- up period of four months to 13 years. Conclusion： The surgery of genitourinary fistulae repair should follow the principle of individual treatment. Adequate preoperative preparation, the appropriate time of surgical repair, the correct surgical repair pathways, intraoperative meticulous skills are keys to the success of genitourina

关 键 词：膀胱阴道瘘 输尿管阴道瘘 尿道阴道瘘 瘘修补术 

分 类 号：R694[医药卫生—泌尿科学] R695[医药卫生—外科学]