膀胱阴道瘘的个体化介入治疗方法分析  

Analysis of individualized interventional treatment of vesicovaginal fistula

作　　者：段鸿鉴 张建好[1] 韩新巍[1] 赵艳萍[1] 候宇虹 杨杰[1] 闫肃 秦胜东 Duan Hongjian;Zhang Jianhao;Han Xinwei;Zhao Yanping;Hou Yuhong;Yang Jie;Yan Su;Qin Shengdong(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450018,China)

机构地区：[1]郑州大学第一附属医院介入科,河南郑州450018

出　　处：《中华介入放射学电子杂志》2022年第1期45-49,共5页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨个体化介入治疗在治疗不同类型膀胱阴道瘘(VVF)的优势及临床应用价值。方法回顾性分析2017年4月至2019年8月郑州大学第一附属医院确诊的VVF患者41例。根据患者VVF类型选择不同的介入治疗方式,其中18例因宫颈癌放疗后VVF患者采用肾造瘘联合输尿管尿流阻断支架植入术,22例因宫颈癌放疗后VVF伴有下段输尿管狭窄患者采用单纯双肾造瘘引流术,1例因长期泌尿系统炎症行膀胱镜检损伤引起VVF患者采用输尿管短期球囊封堵联合肾造瘘引流术。观察患者症状改善情况并统计术后并发症。比较术前和术后1周尿白细胞数、阴道渗液量、血浆肌酐及尿素氮的差异。结果41例患者介入治疗均成功进行,术后所有患者尿漏症状即刻消失。术后1周与术前比较,尿白细胞数、阴道渗液量差异均有统计学意义(P<0.05)。血浆肌酐及尿素氮差异无统计学意义(P>0.05),术后未观察到严重并发症发生。结论对于VVF患者的个体化介入治疗安全有效,应根据患者病情及意愿选择合适的治疗方式,以达到最佳治疗效果。Objective To explore the advantages and clinical application value of individualized interventional therapy in the diagnosis and treatment of different types of vesicovaginal fistula(VVF).Methods A retrospective analysis was performed on 41 patients diagnosed with VVF in the First Affiliated Hospital of Zhengzhou University from April 2017 to August 2019.Different interventional treatment methods were selected according to the patient’s VVF type.Among them,18 patients with VVF after radiotherapy for cervical cancer received concurrent bilateral percutaneous nephrostomy and ureter occlusion stent placement.22 patients with VVF and lower ureteral stenosis after radiotherapy for cervical cancer were treated with bilateral percutaneous nephrostomy.One case with VVF caused by cystoscopy injury due to long-term urinary system inflammation was treated with short-term ureter balloon occlusion combined with nephrostomy.The improvement of symptoms and postoperative complications were observed.The differences of urine white blood cell count,vaginal fluid volume,creatinine and urea nitrogen were compared before and one week after operation.Results All 41 patients were successfully treated with interventional treatment.The symptoms of urine leakage disappeared in all patients immediately after the procedure.Compared with the preoperative period,urine white blood cell count and the amount of vaginal fluid in the first week after operation were significantly different(P<0.05).And there was no statistically significant difference in creatinine and urea nitrogen(P>0.05).No serious complications were observed after treatment.Conclusions Individualized interventional therapy for VVF patients is safe and effective,and appropriate treatment methods should be selected according to the patient’s condition and willingness to achieve the best therapeutic effect.

关 键 词：膀胱阴道瘘 宫颈癌 肾造瘘 输尿管阻断支架 球囊封堵 

分 类 号：R694[医药卫生—泌尿科学] R711.73[医药卫生—外科学]