摘要
目的:探讨经膀胱途径膀胱后壁抬高法修补膀胱阴道瘘的临床应用价值。方法:回顾性分析复旦大学附属中山医院2009年12月~2018年5月11例膀胱阴道瘘(vesicovaginal fistula,VVF)患者的临床资料。11例病因均与子宫切除手术损伤有关,4例曾行VVF修补术失败,3例为多发瘘。全部病例均采用经膀胱途径膀胱后壁抬高法修补膀胱阴道瘘,从出现漏尿到手术时间中位值为7个月(15 d^3年)。结果:患者平均手术时间(126.3±23.5) min,平均术中失血量(93.3±66.4) mL,住院天数中位值6(5~15) d。围手术期未发生尿失禁及ClavienⅡ级以上并发症。术后3周行膀胱造影未见漏尿后拔除膀胱造瘘管。10例(90.9%)一次手术获得成功,1例曾在外院行经阴道VVF修补术的宫颈癌术后放疗患者修补失败,6个月后再次修补成功。全部病例随访1年无复发。结论:经膀胱途径膀胱后壁抬高法VVF修补术,可准确判断瘘口的位置、数目及窦道周围组织结构,有利于充分游离膀胱-阴道间隙、精细切除瘘管瘢痕组织,从而达到无张力缝合的目的。该法适用于较复杂的、复发、多发VVF的修补。
Objective: To investigate the clinical application value of transvesical repair of vesicovaginal fistula via bladder posterior wall elevation technique. Method: The clinical data of 11 patients with vesicovaginal fistula(VVF) from December 2009 to May 2018 at Zhongshan Hospital, Fudan University were retrospectively analyzed. The VVF in all cases was caused by the injury during hysterectomy, in which 4 cases had failed VVF repair, and 3 cases had multiple fistulas. In this study, VVF was repaired via bladder posterior wall elevation technique in all cases. The median waiting time from urine leakage onset to surgery was 7 months(15 d-3 years). Result: The average operation time was(126.3±23.5) min, and the average blood loss during operation was(93.3±66.4) mL, and the median hospital stay was 6 days(5-15 days). No urinary incontinence or Clavien Grade Ⅱ or higher complications occurred during the perioperative period. Cystography was performed at 3 weeks after operation and the cystostomy tube was removed when no urine leakage was found. Ten cases(90.9%) were successfully performed in one operation. One failed case is the patient with the history of postoperative radiotherapy for the treatment of cervical cancer who had undergone transvaginal VVF repair in other hospital but was then successfully operated again 6 months later. All cases were followed up for 1 year without recurrence. Conclusion: Transvesical repair of VVF via bladder posterior wall elevation technique can accurately determine the position and number of fistulas and the tissue structure around the fistula, which is conducive to fully free the bladder-vaginal space and finely remove the scar tissue, thereby achieving tension-free suture. This technique is suitable for the complicated, recurrent and multiple VVF repair.
作者
林敬莱
林登强
赖鹏
刘宇军
胡骁轶
张建平
张立
许明
孙立安
郭剑明
张永康
LIN Jinglai;LIN Dengqiang;LAI Peng;LIU Yujun;HU Xiaoyi;ZHANG Jianping;ZHANG Li;XU Ming;SUN Lian;GUO Jianming;ZHANG Yongkang(Department of Urology,Xiamen Branch,Zhongshan Hospial,Fudan University,Xiamen,Fujian,361015,China;Department of Urology,Zhongshan Hospita,Fudan University)
出处
《临床泌尿外科杂志》
2020年第11期911-915,共5页
Journal of Clinical Urology
