腹腔镜下输尿管膀胱再植术治疗医源性输尿管阴道瘘的疗效  

The effect of laparoscopic cesico-ureteral reimplantation in treatment of iatrogenic ureterovaginal fistula

作　　者：谢文君 李文标[2] 杨飞[2] 丁虹璐 刘柏隆[2] 湛海伦[2] 周祥福[2] Xie Wenjun;Li Wenbiao;Yang Fei;Ding Honglu;Liu Bolong;Zhan Hailun;Zhou Xiangfu(Department of Operation Room,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Urology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院岭南医院手术室,广州510530 [2]中山大学附属第三医院岭南医院泌尿外科,广州510530

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第5期348-350,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金面上项目(81670688)。

摘　　要：目的总结并分析腹腔镜下输尿管膀胱再植术治疗医源性输尿管阴道瘘的疗效。方法回顾性分析2014年6月至2018年1月期间我院收治并行腹腔镜下输尿管膀胱再植术的14例输尿管阴道瘘患者资料。年龄27~69岁,平均(44±5)岁。发现阴道漏尿时间为1~29 d,平均12 d。左侧9例(64.3%),右侧5例(35.7%)。本组所有患者术前均行血常规、生化、泌尿系彩超、美蓝实验、静脉泌尿系造影以及CTU检查确诊。结果本组14例患者手术均成功完成,手术用时100~160 min,平均125 min。术中出血20~100 ml。术后平均3 d拔除腹腔引流管,7~10 d拔除尿管;住院时间9~18 d,平均13 d。术后随访3~24个月,平均13个月,本组全部治愈。术后1例患者出现无痛性肉眼血尿,未行特殊处理嘱多饮水保守治疗后好转(Ⅰ级);2例患者术后出现发热症状,血常规复查提示血白细胞升高,尿常规白细胞升高,予以加强抗感染治疗后好转(Ⅱ级);余患者均无严重并发症(Ⅲ-Ⅴ级)发生。结论引起输尿管阴道瘘的原因主要为妇产科手术所致,对于输尿管阴道瘘建议早期诊断,条件允许的情况下早期手术治疗,腹腔镜下输尿管膀胱再植术治疗输尿管阴道瘘疗效满意。Objective To summarize and analyze the efficacy of laparoscopic ureteral bladder replantation in the treatment of iatrogenic ureterovaginal fistula.Methods A retrospective analysis of 14 patients with ureterovaginal fistula who underwent concurrent laparoscopic ureteral replantation between June 2014 and January 2018.The age ranged from 27 to 69 years,with an average of(44±5)years.The time of vaginal leakage was found to be 1 day to 29 days,with an average of 12 days.9 cases(64.3%)on the left side and 5 cases(35.7%)on the right side.All patients in this group underwent blood routine,biochemical,urinary ultrasound,Meilan experiment,intravenous urography and CTU examination.Results All the 14 patients were successfully operated.The operation time was 100-160 min,with an average of 125 min.Intraoperative bleeding 20~100 ml.Abdominal drainage tube was removed on average 3 days after operation,and the catheter was removed 7 to 10 days.The hospital stay was 9 to 18 days,with an average of 13 days.All patients were followed up for 3 to 24 months,with an average of 13 months.All the patients were cured.One patient developed painless gross hematuria after surgery,and did not undergo special treatment(Class I);2 patients developed fever after operation,and were cured after antiinfective treatment(Class II);the remaining patients had no serious complications.Conclusion Ureteral fistula is mainly caused by gynecological and gynecological surgery,early diagnosis is recommended for ureterovaginal fistula,early surgical treatment is suggested under conditions,and laparoscopic ureteral bladder replantation is satisfactory for ureterovaginal fistula.

关 键 词：医源性 输尿管阴道瘘 输尿管膀胱再植术 腹腔镜 

分 类 号：R699.5[医药卫生—泌尿科学]