自制套管单孔腹腔镜下经膀胱入路膀胱阴道瘘修补术手术技巧及初步结果  

Transvesicle laparoendoscopic single-site surgery for repair of vesicovaginal fistula with a homemade single-port device: initial experience in 6 patients

作　　者：黄海[1] 范新祥[1] 林天歆[1] 李楷文 刘皓[1] 韩金利[1] 许可慰[1] 江春[1] 董文[1] 黄健[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第1期18-21,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家重大项目卫生行业公益性事业专项(200802015);广东省科技项目(9622050-01);广州市科技局重点项目(2005Z2-E0121)

摘　　要：目的探讨经膀胱进行单孔腹腔镜下膀胱阴道瘘修补术的可行性并评价治疗效果。方法2012年1月至2013年4月,我院共为6例膀胱阴道瘘患者实施该手术,腹膜前入路进入膀胱,将自制单孔多通道套管置入膀胱,从通道内置入腹腔镜及两个腹腔镜器械进行操作。从尿道插入输尿管导管入膀胱,并在腹腔镜直视下插入到双侧输尿管内。自阴道从瘘口插入输尿管导管入膀胱,标记切除瘘口。电凝钩切除瘘道疤痕组织,将阴道前壁及膀胱壁充分游离,分层缝合阴道壁及膀胱壁。注入美兰确认瘘口修补成功。结果手术均获成功,无改开放或二次手术。套管制作时间为(3±1)min,通道建立时间为(6±1)min,手术时间(42±21)min,术中出血(40±20)ml,住院时间(9±3)d。术中无并发症发生,术后1例患者出现伤口脂肪液化,愈合延迟。术后4周复查均无尿瘘复发,无输尿管损伤。结论经膀胱进行单孔腹腔镜下膀胱阴道瘘修补术简单易行、安全有效,但操作较常规腹腔镜手术复杂,单孔多通道套管及腹腔镜手术器械有待进一步完善和改进。Objective To evaluate the feasibility and therapeutic effect of transvesicle laparoendoscopic single-site surgery （LESS） for repair of vesicovaginal fistula （VVF） with a homemade single-port device. Methods From January 2012 to April 2013, six patients underwent transvesicle LESS for repair of VVFs in our hospital. The bladder wall was cut open from extraperitoneal approach, and single-port access was placed into bladder cavity. Ureteral catheters were inserted into the bilateral ureter to mark and protect the ureter through urethra under laparoscopy. Another ureteral catheter was insterted into the bladder from vaginal fistula as the guideline of surgical removal of scar. After resection of scar tissue around fistula canal, the anterior vaginal wall and bladder wall were isolated sufficiently. Then the vaginal wall and bladder wall were sutured separately. Results All 6 surgeries were successfully performed without conversion to open surgery or secondary surgery. The mean time for single-port construction was （3 ± 1） min. The mean time for establishment of transvesical single-port access was （6±1） min. The mean operative time was （42± 21） min. The mean volume octrood loss was （40±20） ml. The mean length of hospital stay was （9±3） d. No major intraoperative complation occurred. Fat liquefaction of the incision occurred in an obese patient. According to the results of rollow-up 4 weeks postoperatively, no urine leakage or ureteral damage was identified. Conclusions Transvesicle LESS for repair of VVFs repair is feasible and effective, but is difficultthan conventional laparoscopic surgery. Single-port multi-channel device and laparoscopic instruments need further improvements.

关 键 词：腹腔镜 膀胱阴道瘘 单孔 治疗 

分 类 号：R699[医药卫生—泌尿科学]