改良经阴道路径膀胱阴道瘘修补术的临床应用和疗效  

The application and efficacy of trans-vaginal approach combined with resectoscope for vesicovaginal fistula repair

作　　者：刘锋[1] 黄盛松[2] 李超[2] 刘莺[2] 周伟东[2] 蒋挺[1] 徐晔 杨涛 那扎罗 徐成党 吴登龙[2] LIU Feng;HUANG Shengsong;LI Chao;LIU Ying;ZHOU Weidong;JIANG Ting;XU Ye;YANG Tao;NA Zaluo;XU Chengdang;WU Denglong(Department of Urology,First People's Hospital of Taicang,Taicang 215400;Department of Urology,Tongji Hospital,Tongji University School of Medicine,Shanghai 200065,China)

机构地区：[1]江苏省太仓市第一人民医院泌尿外科,江苏215400 [2]同济大学附属同济医院泌尿外科,上海200065

出　　处：《现代泌尿外科杂志》2021年第7期558-561,共4页Journal of Modern Urology

基　　金：上海市优秀学术带头人计划(No.18XD1403500)。

摘　　要：目的探讨改良经阴道路径膀胱阴道瘘(VVF)修补术的临床应用及疗效。方法回顾性分析2014年1月至2019年12月行经阴道路径VVF修补术36例患者的临床资料。患者中位年龄48.5(33-62)岁,表现为阴道不自觉漏液。32例为妇科手术医源性损伤,4例为外伤;15例为妇科恶性病变者均无盆腔放疗史。14例瘘口位于膀胱三角区以上,17例瘘口位于膀胱三角区,5例瘘口位于膀胱颈部;瘘口中位直径2.0(0.3-4)cm,均为单一瘘口,距输尿管开口>0.5 cm。手术取折刀体位,经阴道置电切镜,以电切环沿瘘口周围切除瘘管黏膜及疤痕组织,沿膀胱阴道间隙切开,分离膀胱、阴道壁,经阴道3-0可吸收缝线分别错位缝合膀胱壁及阴道壁。术后持续留置导尿管2个月以上,行膀胱造影及膀胱镜复查,以阴道漏液消失、膀胱造影剂无渗漏为修补成功标准。修补失败者3个月后以同样方法行修补。结果36例患者均顺利完成手术,中位手术时间50.5(30-80)min,术后平均住院时间(3.0±0.8)d。中位随访时间22(6-30)月。结果显示:31例(86.1%)1次修补成功;5例第1次修补失败,分析显示第1次修补失败病例在既往手术史比率(60.0%vs 6.5%)、中位瘘口直径(3.0 cm vs 2.2 cm)及中位手术时间(60.0 min vs 50.0 min)均高于修补成功患者,差异具有统计学意义(P<0.05);5例修补失败患者3个月后膀胱镜检查皆见瘘口缩小,以同样方法行第2次修补,均获成功。所有患者术后尿控可,无尿潴留。结论VVF修补术创伤小、学习曲线短,且患者住院时间短、术后恢复快,是一种有推广价值的手术方法,适用于瘘口较小、无盆腔放疗史的患者。Objective To investigate the application and efficacy of modified trans-vaginal approach for vesicovaginal fistula(VVF)repair.Methods The clinical data of 36 patients with VVF managed with the modified trans-vaginal approach during Jan.2014 and Dec.2019 were retrospectively analyzed.The median age of the patients was 48.5 years(33-62 years).The manifestation was vaginal involuntary leakage of urine.Of all 36 cases,32 were caused by iatrogenic injury of gynecological surgery,and 4 by trauma.Fifteen of these patients were malignant and none of them had a history of pelvic radiotherapy;15 cases had gynecological malignant lesions,none of which had a history of pelvic radiotherapy.The fistula was located above the vesical triangle in 14 cases,in the vesical triangle in 17 cases,and in the bladder neck in 5 cases.The median fistula diameter was 2.0 cm(0.3-4 cm),and all fistulas were single,0.5 cm away from the ureteral opening.Patients were on Jackson knife position during the operation.Vaginal mucosa around the fistula was opened circularly to the muscle layer with LEEP under resectoscope,then the fistula was dissociated directly or under the assistance of laparoscopy.3-0 Ethicon polyglycolic sutures were used to close the bladder wall and vaginal wall separately.The catheter was indwelt for more than 2 months after operation.Retrograde cystography and cystoscopy were performed 2 months later.The disappearance of symptoms like vaginal leakage of urine and no contrast medium leakage indicated surgical success.Surgical failure was managed in the same approach after 3 months.Results All patients completed the operation successfully.The median operation time was 50.5 min(30-80 min),mean hospitalization time 3.0±0.8 days,and median follow-up 22 months(6-30 months).Thirty-one cases(86.1%)were successfully repaired in one-stage operation,while 5 cases failed and received a second-stage operation.Patients failed in the first-stage operation had higher rate of repair history,lager fistula diameter and longer operation time.N

关 键 词：膀胱阴道瘘 瘘口修补 阴道路径 治疗效果 

分 类 号：R691.6[医药卫生—泌尿科学]