摘要
目的 探讨子宫膀胱瘘(VUF)发生的病因、诊断和治疗方法。方法 回顾性分析北京协和医院2000年1月至2021年7月收治的6例VUF患者的临床资料,并通过检索近20年的中英文文献筛选出276例病例,对这282例患者的临床资料进行汇总分析,同时进行文献复习。结果 282例患者中,VUF发生最主要的病因是子宫下段剖宫产,占87.23%;其最常见、最具特征的临床症状是周期性血尿,占61.61%。VUF常用的影像学诊断方法包括超声、膀胱镜、磁共振成像(MRI)、宫腔造影、膀胱造影和CT尿路造影(CTU)等,其中MRI对发现VUF有独特的诊断价值。97.15%的VUF患者通过手术修补瘘口,术后愈合良好。结论 VUF常为医源性疾病,多继发于剖宫产术后,术中仔细解剖有助于预防VUF发生。MRI是识别异常窦道的有效手段,单纯膀胱镜检查存在误诊或漏诊的风险。手术修补是根本的治疗方式,整体预后较好。
Objective:To investigate the etiology,diagnosis and treatment of vesico-uterine fistula(VUF).Methods:The clinical data of 6 patients with VUF admitted to Peking Union Medical College Hospital from January 2000 to July 2021 were retrospectively analyzed.Another 276 cases were selected by searching the Chinese and English literature in recent 20 years.The clinical data of 282 patients were included for further analysis and literature review.Results:Of 282 patients,the main etiology of VUF is lower segment cesarean section,accounting for 87.23%.The most common and characteristic clinical symptom is periodic hematuria,which can occur in 61.61%of patients.Imaging examinations for VUF mainly include ultrasound,cystoscopy,MRI,hysterography,cystography and CT urography(CTU).MRI has unique diagnostic value in discovering VUF.97.15%of VUF patients underwent surgical treatment to repair the fistula and recovered well after surgery.Conclusions:VUF is usually an iatrogenic disease,mostly secondary to cesarean section.Careful dissection during operation is helpful to prevent VUF.MRI is an effective method to identify abnormal sinus.Application of cystoscopy alone has the risk of misdiagnosis or missed diagnosis.Surgical repair is the primary treatment,and patients recovered well after surgery.
作者
谷智越
史精华
张晶
吴瑜诗
张晨昱
鄢海蓝
冷金花
李晓燕
GU Zhi-yue;SHI Jing-hua;ZHANG Jing;WU Yu-shi;ZHANG Chen-yu;YAN Hai-lan;LENG Jin-hua;LI Xiao-yan(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Clinical Research Center for Obstetric&Gynecologic Diseases,Beijing 100730)
出处
《生殖医学杂志》
CAS
2022年第11期1539-1544,共6页
Journal of Reproductive Medicine
