经阴道修补不同位置膀胱阴道瘘的疗效观察  

The influences of the fistula＇s location on the procedure and outcome of a transvaginal vesicovaginal repair

作　　者：陈宇珂[1] 虞巍[1] 杨洋[1] 段继宏[1] 肖云翔[1] 吴士良[1] 2016m9-30、

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》2016年第12期892-895,共4页Chinese Journal of Urology

摘　　要：目的 探讨瘘口位置高低对经阴道膀胱阴道瘘修补术难易程度和手术成功率的影响.方法 回顾性分析2009年1月至2016年8月我院68例接受经阴道膀胱阴道瘘修补术患者的临床资料.年龄23～64岁,中位年龄46岁.对手术成功与否进行危险因素分析,同时比较了瘘口位置位于膀胱颈、膀胱三角区、三角区以上病例的手术时长和术中出血情况.结果 瘘口分布于膀胱颈、膀胱三角区和膀胱三角区以上的比例分别为7.4％ （5/68）、33.8％ （23/68）、58.8％（40/68）.修补手术总成功率为88.2％ （60/68）.对修补术成功与否进行危险因素分析,位于膀胱颈区、膀胱三角区和膀胱三角区以上的膀胱阴道瘘修补的成功率分别为80.0％ （4/5）、91.3％ （21/23）和87.5％ （35/40）,差异无统计学意义（P=0.757）.既往手术次数是瘘口修补成功与否的唯一危险因素（P=0.019）,而瘘口位置高低、病程长短、瘘口大小和瘘口数量不是瘘口修补成功与否的危险因素（均P＞0.05）.瘘口位置高低对修补术时长和术中出血量无明显影响（均P ＞0.05）.结论 瘘口位置的高低对经阴道膀胱阴道瘘修补术的成功率、手术时长和术中出血量无明显影响.术者不应该仅根据瘘口位置的高低来选择手术入路方式.Objective To explore influences of the fistula＇s location on the procedure and outcome of a transvaginal vesicovaginal （VVF） repair.Methods The medical data of patients undertaken transvaginal VVF repairs in Peking University First Hospital between Janurary 2009 and Auguest 2016 were retrospectively collected,including age,past history,causes of the fistula,disease course,past treatment,outcomes of the cystoscopy and imaging test and surgical information.The follow-ups were performed.Patients who had incomplete clinical data and lost to follow-up were not included.The present study included 68 VVF subjects with the median age of 46 years （range：24-64 years）.The univariate analysis was performed to figure out potential risk factors for the VVF repair outcome.The duration and blood loss of VVF repairs were compared among the subjects with the fistulae located at bladder neck,trigone and supra-trigone region.Results There were 5,23 and 40 cases having VVFs located at bladder neck,trigone and supratrigone region respectively.The overall repair success rate was 88.2% （60/68）.According to results of the univariate analysis,subjects with more past repair times had significantly lower success rates.There were no significant differences in success rates of surgical repairs for VVFs located at bladder neck （80.0%,4/5）,trigone （91.3%,21/23） and supra-trigone region （87.5%,35/40）.And the location of VVFs had no significant association with the duration and blood loss during the VVF repair.Conclusions The location of VVFs had no influences on the procedure and outcomes of the transvaginal repairs.The VVF repair approach may not be determined based on the fistula＇s location alone.

关 键 词：膀胱阴道瘘 经阴道 修补术 瘘口位置 治疗结果 

分 类 号：R699.5[医药卫生—泌尿科学]