经阴道和经腹术式治疗复杂型膀胱阴道瘘的经验总结  

The surgical treatment for complex vesicovaginal fistula

作　　者：陈宇珂[1] 杨洋[1] 虞巍[1] 段继宏[1] 肖云翔[1] 吴士良[1] 

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》2017年第10期737-740,共4页Chinese Journal of Urology

摘　　要：目的 探讨经阴道和经腹修补术式治疗复杂型膀胱阴道瘘的经验.方法 回顾性分析2009年1月至2016年12月我院收治的63例复杂型膀胱阴道瘘患者的临床资料.年龄26～60岁,中位年龄46岁.体重指数16.0～30.0 kg/m2,中位数为24.2 kg/m2.96.8％ （61/63）的患者为妇科手术继发膀胱阴道瘘,其他发病原因包括：剖宫产手术（1例）,阴道整形手术（1例）.1例病程30年;其余62例病程3～84个月,中位数为45个月.其中32例接受经阴道逐层缝合修补法（经阴道修补组）,31例接受经腹腹膜后组织垫入修补法（经腹修补组）.经阴道修补组中有既往修补手术失败史的比例（93.8％,30/32）显著高于经腹修补组（74.2％,23/31,P=0.034）.经阴道修补组和经腹修补组中瘘口数量≥2个者分别为6例（18.8％）和9例（29.0％）.经腹修补组的瘘口最大径显著大于经阴道修补组（中位数：1.0cm与0.5cm,P＜0.001）.结果 经腹修补组31例中,2例术后出现伤口脂肪液化,予规律换药后愈合;经阴道修补组无手术伤口并发症出现.经腹修补组中1例出现粘连性肠梗阻,予保守治疗后好转.经阴道修补组和经腹修补组的中位随访时间分别为24个月（8～102个月）和29个月（8 ～78个月）,手术成功率分别为75％ （24/32）和93.5％（29/31）.经腹修补组中,除1例修补失败患者出现明显的下尿路症状（尿频、夜尿增多）外,其余患者均于术后3～6个月恢复正常膀胱容量,无明显下尿路症状和手术相关并发症出现;经阴道修补组无手术相关并发症出现.结论 考虑到两种术式的创伤程度和瘘口情况等因素,术者应根据具体情况个体化选择经阴道逐层缝合法或经腹腹膜后组织垫人法治疗复杂型膀胱阴道瘘,同时术者也应重视术前检查、术前准备和术后随访.Objective To discuss the outcomes of transvaginal repair and transabdominal repair for complex vesicovaginal fistula （VVF）.Methods The data of complex VVF patients undergoing surgical repair in Peking University First Hospital were retrospectively collected between January 2009 and December 2016.The surgical modalities for complex VVF included transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition.The subtype distribution of complex VVF in transabdominal repair group and transvaginal repair group were recorded.The present study included 63 complex VVF patients with the median age of 46 years （range 26-60 years）.There were 32 cases undergoing transvaginal repair with layered closure and 31 cases undergoing transabdominal repair with full thick vascular peritoneal interposition.The proportion of cases having failed previous repairs was significantly higher in transvagical repair group （30/32 vs.23/31,P =0.034）.Compared with patients with transvaginal repair,patients with transabdominal repair tended to have multiple VVF without statistic significance （18.8% vs.29.0%,P =0.338）.Patients with transabdominal repair had larger VVF than patients with transvaginal repair （median：1.0cm vs.0.5cm,P 〈 0.001）.Results There were 2 cases suffering from fat liquefaction of surgical incision and 1 case suffering from adhesive intestinal obstruction in patients undergoing transabdominal repair.In the median follow-up duration of 24 months （range 8-102 months）and 29 months （range 8-78 months）,the successful rates of transvaginal repair and transabdominal repair were 75% （24/32） and 93.5% （29/31）.Severe lower urinary tract symptoms occurred in one patient who had urine leakage after transabdomnal repair.The bladder volume of patients in transabdominal group recovered at postoperative 3-6 months.Conclusions In consideration of surgical invasion and fistula condition,transvaginal repair with layered closure and transabdominal repair wi

关 键 词：复杂型膀胱阴道瘘 经阴道修补 经腹修补 治疗效果 

分 类 号：R699[医药卫生—泌尿科学]