经腹腹腔镜治疗妇科术后膀胱阴道瘘的初步体会  

Transperitoneal laparoscopy in the treatment of vesicovaginal fistula caused by gynecologic surgery

作　　者：赖彩永[1] 欧阳鹏 林基通 张廷顺 李浩民 胡先国 雷斌[1] 梁蔚波[1] Lai Caiyong;Ouyang Peng;Lin Jitong;Zhang Tingshun;Li Haoming;Hu Xianguo;Lei Bin;Liang Weibo(Department of Urology,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Urology,the General Hospital of Yangxi Hospital Group,Guangdong,529800,China)

机构地区：[1]暨南大学附属第一医院泌尿外科,广州51000 [2]阳西县医院集团总医院泌尿外科,广东529800

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第1期64-67,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：阳江市科技局医疗卫生类科技计划项目(2018126)。

摘　　要：目的总结经腹途径腹腔镜在膀胱阴道瘘修补中的可行性及疗效。方法2012年12月至2017年12月暨南大学附属第一医院因子宫全切除(n=6,均为开放手术)或宫颈癌根治术后(n=1)致膀胱阴道瘘患者共7例,年龄42~57岁,所有瘘口均位于输尿管嵴以上,瘘口直径0.5~3.5 cm,尿瘘病史3个月~5年余,其中2例既往有1~2次经膀胱修补失败病史。采用经腹腹腔镜下膀胱阴道瘘修补术,直视下放置操作通道,其中5例瘘口较大或复发性膀胱阴道瘘采用大网膜填充膀胱与阴道之间的间隙。术后留置尿管2~3周。结果7例患者手术均顺利完成,手术时间150~280 min,出血量50~150 ml,无输血,术后拔除尿管后尿瘘消失。随访6~54个月未出现尿瘘。结论经腹腹腔镜修补高位膀胱阴道瘘微创、有效,尤其是复发性病例,但尚需更多临床资料论证。Objective To summarize feasibility and efficacy of transperitoneal laparoscopy in the treatment of vesicovaginal fistulas.Methods Between December 2012 and December 2017,7 patients(aged 42-57 years)who had underwent open total hysterectomy(n=6)or radical resection of cervical cancer(n=1)caused vesicovaginal fistulas.The fistulas were located above the ureteral fistula,the fistula diameter was 0.5-3.5 cm,and the duration of urinary fistula was between 3 months and 5 years.Among them,2 cases had a history of bladder repair failure 1-2 times.Laparoscopic repair of vesicovaginal fistulas was performed.Trocar was placed under direct vision.Five of them had large or recurrent vesicovaginal fistulas using an omentum to fill the gap between bladder and the vagina.Indwelling catheter for 2-3 weeks.Results All operation were performed successfully,the operation time was 150-280 minutes and the blood loss was 50-150 ml.No blood transfusion was required.After the catheter was removed,the urine fistula disappeared.No urinary fistula occurred during 6-54 months of followup.Conclusion Laparoscopic repair of high vesico-vaginal fistula is minimally invasive and effective,especially in recurrent cases,but more clinical data are needed to demonstrate.

关 键 词：腹腔镜 膀胱阴道瘘 修补术 

分 类 号：R713[医药卫生—妇产科学]