改良经肛门路径修补根治性前列腺切除术后膀胱直肠瘘的疗效分析  

Modified transanal repair of vesicorectal fistula after radical prostatectomy

作　　者：黄盛松[1] 李超[1] 刘莺[1] 吴刚[1] 周伟东[1] 乐威[1] 徐成党 蒋惠阳 姚怿聪 吴登龙[1] Huang Shengsong;Li Chao;Liu Ying;Wu Gang;Zhou Weidong;Le Wei;Xu Chengdang;Jiang Huiyang;Yao Yicong;Wu Denglong(Department of Urology,Tongji Hospital of Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院泌尿外科,上海200065

出　　处：《中华泌尿外科杂志》2021年第1期1-5,共5页Chinese Journal of Urology

摘　　要：目的探讨改良经肛门路径修补根治性前列腺切除术后膀胱直肠瘘的疗效。方法回顾性分析2011年9月至2019年12月同济大学附属同济医院采用经肛门路径修补根治性前列腺切除术后膀胱直肠瘘的32例患者的临床资料。平均年龄72.5(61~76)岁,瘘口皆位于吻合口附近,平均直径19(3~40)mm;24例瘘口为1个,8例瘘口≥2个。32例修补术前均行膀胱造瘘及结肠造口术。修补手术采用折刀体位,经肛门以电切镜切除瘘管,并分离膀胱、直肠壁后行瘘口修补术。术后予解痉、抗感染处理,保留膀胱造瘘管。术后3个月复查膀胱造影及膀胱镜,修补成功者拔除膀胱造瘘管。以气粪尿消失且肛门无漏液,同时影像学检查未发现瘘口为修补成功标准。结果 32例共行39次修补术,手术时间平均67(55~125)min。第1次修补术后中位随访22(6~30)个月。修补成功31例(96.8%),其中1次修补成功25例,重复修补成功6例(其中2次手术修补成功5例,3次手术修补成功1例,所有重复修补均为经肛门路径);修补失败1例,因患者术前曾接受盆腔外放射治疗,修补失败后膀胱镜检查见瘘口大、周围组织僵硬,遂行双侧输尿管皮肤造口、膀胱切除术,患者最终尿粪改道生存。结论采用改良经肛门路径修补根治性前列腺切除术后膀胱直肠瘘创伤小、并发症少,可重复手术;其疗效确切,成功率高,较适合于低位、瘘口较小、未经放疗的患者。Objective To investigate the effect of modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy.Methods From September 2011 to December 2019,32 cases of vesicorectal fistula after radical prostatectomy were retrospectively analyzed.All patients underwent cystostomy before repair operation.The average diameter of the fistulas was 19(3-40)mm.There was only one fistula in 24 cases and 8 cases with more than 2 fistulas.The operation was performed in the jack knife position,and the fistula was prepared by resection of the fistula through the anus with bipolar resectoscope.Then bladder wall and rectum wall were separated by the loop and sutured respectively.After operation,the patients were treated with antispasmodic and anti-infective treatment,and the catheter was retained.Cystography and cystoscopy were reexamined 3 months after operation.Catheter was removed in the successful cases,and the failure was repaired again.Results All operations were completed successfully.The mean operation time was 67(55-125)min,and the median follow-up was 22(6-30)months.Thirty-one cases(96.8%)were successfully repaired,of which 25 cases were successfully repaired at the first operation,and 6 cases were successfully repaired again(all by transanal route).One case failed to be repaired.He had received external pelvic radiotherapy before operation.After the failure of repair,cystoscopy showed large fistula and stiff surrounding tissue.Then bilateral ureteral skin stoma and cystectomy were performed.Conclusions Modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy is an effective method.This kind of operation has less trauma,fewer complications and can be operated repeatedly.It is suitable for patients with low position,small fistula and without radiotherapy.

关 键 词：瘘 膀胱直肠瘘 根治性前列腺切除术 经肛门 手术 

分 类 号：R699.8[医药卫生—泌尿科学]