输尿管阴道瘘15例诊治体会

Experience on the Diagnosis and Treatment of 15 Cases with Ureterovaginal Fistula

【目的】探讨榆尿管阴道瘘的诊断、治疗方法与手术时机。【方法】回顾性分析2002～2008年本院诊治的15例输尿管阴道瘘患者的临床资料。诊断手段包括B超、静脉尿路造影（IVU）、美兰试验、膀胱镜及逆行肾孟插管造影；其中，13例早期行输尿管镜下放置双J管术，6例（包括输尿管镜下放置双J管术失败的4例）行输尿管膀胱再植术。【结果】15例患者中13例早期行输尿管镜下放置双J管术后有9例（69．2％）获得治愈，4例输尿管镜下放置双J管术失败后改为输尿管膀胱再植术获得治愈，另外2例病程3个月以上者直接行输尿管膀胱再植术获得治愈，随访6～31个月（平均10．3个月），所有患者均无阴道流尿。【结论】输尿管镜下置入双J管术是早期处理输尿管阴道瘘的首选治疗方法，失败后可再选择输尿管膀胱再植术。

[Objective] To study the diagnosis and treatment of ureterovaginal fistula. [Methods] Fifteen cases with ureterovaginal fistula from 2002 to 2008 were treated and the clinical data were reviewed. Diagnostic methods included B-ultrasound intravenous urography（IVU）, dye test, cystoscope and retrograde pyelography. Thirteen cases were treated early with placing double J-stent by using a ureteroscope. Six cases underwent ureterocystostomy （including 4 cases failed in the treatment of placing double J-stent by ＇using ureteroscope）. [Results] Nine of thirteen cases were cured and double J-stents were successfully placed in them by ureteroscope. The cure rate was 69.2%. Four eases in which double J-stents were unsuccessfully placed by ureteroscope underwent ureterocystostomy and were cured. Two cases with a course of over 3 months directly underwent ureterocystostomy and were cured. The follow-up from 6 months to 31 months （average 10. 3 months） showed that all of the 15 cases had been cured and had no urinary fistula. [Conclusion] Early repair of ureterovaginal fistula is recommended. To insert double J-stent to ureter by ureteroscope is an effective way to treat ureterovaginal fistula. After failure of inserting stent to ureter, ureterocystostomy is a good choice.