手术后输尿管阴道瘘42例临床诊治

Diagnosis and treatment for ureterovaginal fistula due to operation

目的:探讨输尿管阴道瘘的诊断、治疗方法与时机。方法:分析42例妇产科术后输尿管阴道瘘患者的临床资料,诊断手段包括阴道漏尿病史、B超、静脉尿路造影(IVU)、美蓝试验、膀胱镜及逆行肾盂插管;治疗中,1例行左肾切除术,4例行输尿管内双J管置入术,37例行输尿管膀胱再植术,其中于发现漏尿后即时修复32例,延迟修复5例。结果:患者均于术前确诊,手术治疗一次成功,随访3月至7年,效果满意。结论:早期修复输尿管阴道瘘是适宜的。支架管置入失败后,输尿管膀胱再植术是治疗输尿管阴道瘘的主要方法。

Objective： To study the diagnosis and treatment for ureterovaginal fistula. Methods： 42 cases with ureterovaginal fistula which developed after gynecological procedures were treated and the clinical data were reviewed. Diagnostic methods included the history of vaginal leakage, Bultrasound, intravenous urography （IVU）, dye studies, cystoscopy and retrograde pyelography. Nephrectomy was undertaken in 1 case and double J stent was placed in 4 cases. 32 of 37 patients underwent ureterocystostomy as soon as the fistula occurred while the other 5 patients had deferred treatment. Results：All cases who were established before operation underwent successful procedure and have been followed up for 3 months to 7 years with satisfactory result. Conclusions： Early repair of ureterovaginal fistula was recommended. After failure of inserting stent to ureter, ureterocystostomy is the main operative procedure for the treatment of ureterovaginal fistula.