经阴道途径“深埋法”手术治疗膀胱阴道瘘  

"Deep buried method"via transvaginal surgery in treatment of vesicovaginal fistula

作　　者：涂洋 刘相臣 皇甫雪军[1] 刘中华[1] 范志强[1] TU Yang;LIU Xiangchen;HUANGFU Xuejun;LIU Zhonghua;FAN Zhiqiang(Department of Urology,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,450003,China)

机构地区：[1]河南大学人民医院泌尿外科,郑州450003

出　　处：《临床泌尿外科杂志》2020年第12期954-957,962,共5页Journal of Clinical Urology

摘　　要：目的:探讨经阴道途径"深埋法"手术治疗膀胱阴道瘘(vesicovaginal fistula,VVF)的技术要点和临床疗效。方法:回顾性分析2017年1月~2020年1月采用经阴道途径"深埋法"手术治疗12例VVF患者的临床资料。年龄13~56岁,平均44.5岁;BMI 19.7~34.4 kg/m2;病程3个月~20年,平均32个月。所有患者术前均行膀胱镜检查明确瘘的数目、位置、大小、周围组织瘢痕情况以及瘘口与双侧输尿管开口的距离,本组2例予以留置左侧输尿管支架管。截石位显露瘘口,将瘘及周围瘢痕组织尽可能切除,"深埋法"多层无张力缝合关闭瘘口。术后定期随访排尿情况,术后3个月时复查膀胱镜及阴道镜。结果:12例患者手术过程顺利。手术时间90~130 min,平均110 min;出血量10~30 mL,平均15 mL:住院时间5~14 d,平均8 d;留置尿管时间为14~24 d,平均21 d。术后随访3~24个月,12例患者均无失访,11例痊愈,1例复发。结论:经阴道途径"深埋法"治疗VVF是一种创伤小、成功率高、并发症少的方法,值得临床推广。Objective:To evaluate the technique and clinical efficacy of the"deep buried method"via transvaginal surgery for treating vesicovaginal fistula.Method:Data of 12 patients with vesicovaginal fistula treated with the"deep buried method"via transvaginal surgery from January 2017 to January 2020 were retrospectively analyzed.The age ranged from 13 to 56 years old(mean,44.5 years old).The body mass index was 19.7-34.4 kg/m^2.The course of disease was from 3 months to 20 years(mean,32 months).Before operation,cystoscopy was performed in all patients to determine the number,location,size,scarring condition of the surrounding tissue and distance from bilateral ureteral orifices of the fistula,and the left ureteral stent was retained in 2 patients.The lithotomy position was used to expose the surgical field,and the fistula and surrounding scar tissue were removed as much as possible.The fistula closed with the"deep buried method"should be multi-layer and tension-free suture.Urination was regularly followed up after surgery,and cystoscopy and colposcopy were reviewed at 3 months after surgery.Result:All 12 cases were smoothly repaired.The operation time ranged from 90 to 130 minutes(mean,110 minutes).The blood loss was from 10 to 30 mL(mean,15 mL).The patients were discharged from hospital 5 to 14 days after the operation(mean,8 days).The catheter indwelling time was from 14 to 24 days(mean,21 days).All 12 patients were followed up for 3 to 24 months.Eleven cases healed,but 1 case recurred.Conclusion:The"deep buried method"via transvaginal surgery in treatment of vesicovaginal fistula proved to be a method with little trauma,high success rate and less complications,which is worthy of clinical promotion.

关 键 词：膀胱阴道瘘 经阴道修补术 外科手术 治疗 

分 类 号：R694[医药卫生—泌尿科学]