产科尿瘘修补时机的临床探讨

Clinical study on the proper time for treatment of obstetric fistulas.

目的:探讨产科尿瘘的治疗时机和方法。方法:对427例分娩后产科瘘发生的病例进行即刻处理,方法为应用导尿管和(或)尽早行修补术,大量饮水而不用抗生素。按解剖生理位置分类将产科瘘分为Ⅰ型、ⅡAa型、ⅡAb型、ⅡBa型、ⅡBb型、Ⅲ型,按照瘘孔的大小分为小、中、大、超大型。结果:经首次处理407例(95.3%)瘘孔关闭,另外14例再处理后瘘孔关闭,最后共治愈421例患者,占98.6%。其中66例患者经放置导尿管治愈,占15.5%。所有治愈患者中,术后排尿正常392例(93.11%),并发尿失禁29例(6.89%)。瘘孔关闭率从Ⅰ型到ⅡBb型和从小瘘孔到超大瘘孔逐渐降低。术后无一例切口感染。结论:产科瘘孔发生后的即刻处理对瘘孔的关闭和减少尿失禁发生率效果非常明显,并且大大降低了患者的身心痛苦。此方法方便、简易、有效,是一种非常可行的尿瘘处理方法。

Objective：To study the proper time and method for treatment of obstetric fistulas, nethods：A total of 427 patients with a fistula were treated immediately by catheter and/or early closure. Instead of antibiotics, enough liquid was necessary. The fistulas were clas- sifted according to anatomic and physiologic location in types Ⅰ , Ⅱ Aa, ⅡAb, ⅡBa, ⅡBb, Ⅲ, and according to size in small, medium, large, and extensive. Results： At first attempt 407 fistula （95.3%） were closed and another 14 were cloud at further attempt,accounting for a final clo- sure in 421 patients （98.6%） ;66 patients （ 15.5% ） were healed by catheter only. Of these 421 patients with a closed fistula,392 （93.11% ） were continent and 29 （6.89%） were incon- tinent. The results as to closure and to continence became progressively worse from type Ⅰthrough type ⅡBb and from small through extensive. Postoperative wound infection was not not- ed. Conclusion： This immediate management proves highly effective in terms of closure and continence and will prevent the patient from becoming an outcast with progressive downgrading medically, socially, and mentally.