球海绵体肌瓣在女性复杂性膀胱阴道瘘修补术中的应用

The bulbocavernous muscle flap in the reparation of complicated vesicovaginal fistula

目的探讨球海绵体肌瓣修补女性复杂性膀胱阴道瘘的应用价值。方法女性复杂膀胱阴道瘘患者11例，均有瘘修补失败史，均经膀胱镜检查确诊，瘘口直径3．0～5．0cm。经腹会阴途径修补，瘘口周围瘢痕组织经腹彻底切除。会阴部切口，自阴道前壁和尿道后壁之间分离至瘘口，用可吸收线缝合阴道侧瘘口。沿大小阴唇之间纵行切开，游离球海绵体肌，避免损伤会阴外动脉血供。经小阴唇底部打一隧道，将球海绵体肌瓣通过隧道，阴蒂端经膀胱瘘口缝合于子宫前壁下端，缝合膀胱裂口。结果11例患者术后均无阴道漏尿及尿失禁。随访6个月～5年，患者均无尿道狭窄，10例已婚者性生活正常。结论球海绵体肌瓣移位术操作简单，成功率高，尤其适用于修补女性复杂膀胱阴道瘘。

Objective To explore the application of the bulbocavernous muscle flap for repairing complicated vesicovaginal fistulas. Methods Eleven complicated cystovaginal fistulas patients with histories of failing repairing vesicovaginal fistulas were included in this study. The fistula was confirmed by cystoscopy. The diameter of vesicovaginal fistula was 3.0～5.0 cm. The vesicovaginal fistulas were repaired by combined abdominal perineal approaches. Through an abdominal approach, the scar tissue around fistula was resected thoroughly. A perineal incision was made between urethra and vagina,dissecting to the fistula. The vagina defect was closed using absorbable sutures. The bulbocarvernous muscle was freed through an incision between labium majus pudendi and labium minus pudenda, without damaging the pudendal vascular supply. The bulbocavernous muscle flap was tunneled beneath the labium minus pudenda, and was sutured in inferior extremity of anterior uterine wall. The bladder defect was then closed. Results Eleven patients with complicated vesicovaginal fistulas were operated using this technique. No leakage from the vagina and urinary incontinence was reported postoperatively in all patients. The patients were followed up for 3 months to 5 years, there were no urethral stricture and 10 married patients had normal sexual function. Conclusions Transposition of the bulbocavernous muscle flap could be a useful technique for repairing complicated vesicovaginal fistulas.