不同手术方法治疗膀胱阴道瘘

发布时间：2018-07-12 19:41

本文选题：膀胱阴道瘘 + 治疗　；参考：《北京大学学报(医学版)》2017年05期

【摘要】：目的:比较不同手术术式治疗膀胱阴道瘘的易行性及患者预后,评价电凝术用于小直径膀胱阴道瘘治疗的价值。方法:选择北京大学人民医院泌尿外科2008年10月至2016年11月收治并持续随访的膀胱阴道瘘患者资料进行回顾性分析,共计19例,患者年龄31~55岁,中位年龄48岁;病程1~24个月,中位病程3个月,比较不同手术术式用于膀胱阴道瘘治疗的瘘口情况和手术预后等是否存在差异。结果:3例行电凝术,4例经阴道修补,7例开放腹腔切开膀胱前壁进行修补,5例进行腹腔镜修补。除1例患者拒绝留置尿管和D-J管外,其余患者术后常规留置尿管与双侧D-J管。68.2%的病例(13例)手术成功,术后未再发生阴道漏液。63.2%的病例(12例)手术一次成功,术后平均1.5个月完全恢复。3例行电凝术修复的患者,1例重复手术2次,术后1个月恢复,另外2例均在术后1个月拔除尿管和D-J管后恢复;4例经阴道修补的患者,3例在术后1个月拔出尿管和D-J管后恢复,1例术后恢复差;7例开放手术的患者中,5例手术效果好,术后恢复佳,1例转外院继续治疗,1例于北京大学人民医院进行二次手术,预后仍差;5例腹腔镜修复的患者,3例一次手术成功,术后1个月拔管后痊愈,2例患者于外院进行二次手术,术后愈合差。电凝术用于治疗膀胱阴道瘘,手术简便易行,手术时间短,住院时间短,患者恢复佳。结论:电凝术创伤小,出血少,效果好;经阴道修补适合瘘口位置低,利于暴露手术视野的病例;开放手术、腹腔镜手术适合复杂性膀胱阴道瘘,尤其是需要同时处理输尿管开口狭窄、输尿管瘘等并发症的病例,但手术时间长、出血多、创伤大,不利于术后恢复。对于单一瘘口、瘘口直径小的膀胱阴道瘘推荐首选电凝术。
[Abstract]:Objective: to compare the feasibility and prognosis of different surgical procedures for vesicovaginal fistula and evaluate the value of electrocoagulation in the treatment of small diameter vesicovaginal fistula. Methods: the data of 19 patients with vesicovaginal fistula admitted from October 2008 to November 2016 in the Department of Urology, people's Hospital of Peking University were retrospectively analyzed. The patients aged 31 to 55 years with a median age of 48 years and the course of disease ranged from 1 to 24 months. The median course of 3 months was compared between different surgical procedures for the treatment of vesicovaginal fistula situation and surgical prognosis. Results 3 cases underwent electrocoagulation and 4 cases underwent vaginal repair. 7 cases were open abdominal cavity incision and 5 cases underwent laparoscopic repair. Except for one patient who refused to indwelling urethral catheter and D-J catheter, 13 cases (13 cases) with bilateral D-J tube and routine indwelling catheter were successfully operated on, and no vaginal leakage occurred in 12 cases (12 cases). The average recovery was 1.5 months after operation. 3 patients who underwent electrocoagulation repair had 2 repeated operations, and recovered 1 month after operation. In the other 2 cases, 4 patients recovered after the removal of urinary catheter and D-J tube, 3 patients recovered after 1 month of extraction of urinary catheter and 1 patient recovered after D-J tube, 5 of 7 patients with open operation had good results. After operation, 1 case of good recovery was transferred to other hospital and 1 case underwent second operation in the people's Hospital of Peking University. The prognosis was still poor in 5 cases of laparoscopic repair. 3 cases were successfully operated on at one time. One month after extubation, 2 patients were cured in the hospital, and the healing was poor. Electrocoagulation is used to treat vesicovaginal fistula. The operation is simple and easy, the operation time is short, the hospital stay is short, the patient recovers well. Conclusion: electrocoagulation has the advantages of less trauma, less bleeding and better effect. Transvaginal repair is suitable for cases with low fistula location and favorable exposure of surgical field of vision, open surgery and laparoscopic surgery are suitable for complicated vesicovaginal fistula. Especially, the complications of ureteral orifice stenosis and ureteral fistula need to be treated simultaneously, but the operation time is long, the bleeding is much and the trauma is great, which is not conducive to postoperative recovery. For single fistula, vesicovaginal fistula with small fistula diameter is recommended as the first choice of electrocoagulation.
【作者单位】：北京大学人民医院泌尿外科;
【分类号】：R699

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