膀胱结肠瘘临床诊治分析

Diagnosis and treatment of enterovesical fistula(report of 6 cases)

目的:探讨膀胱结肠瘘的诊治方法,提高其诊治水平。方法:回顾性分析6例膀胱结肠瘘患者的诊治资料。男性5例,女性1例。病因为结肠癌4例、结肠憩室炎2例。临床主要表现为粪尿、气尿及反复尿路感染。通过CT确诊4例、膀胱镜确诊2例、膀胱造影确诊1例。6例全部行手术治疗,其中病变肠段切除一期吻合加膀胱部分切除术2例,膀胱瘘口外长补1例;一期横结肠造口、二期结肠癌根治加膀胱部分切除术2例;1例结肠癌患者因肿瘤有远处转移,仅行横结肠造口术。结果:6例随访5个月～3年,平均2.2年。除1例结肠癌于术后5个月死于肿瘤转移外,其他患者术后生存良好,无明显术后并发症。结论:膀胱结肠瘘主要病因为肠道病变,临床表现为反复尿路感染及粪尿等,CT三维重建为首选的检查方法,治疗以手术为主。

Objective：To assess the diagnosis and treatment of enterovesical fistula.Methods：The clinical data of 6 cases（5 men and 1 women;mean age）of enterovesical fistula were retrospectively analyzed.The etiology of fistula was intestinal malignancy in 4 cases,intestinal diverticulitis 2.The clinical features included fecaluria、recurrent urinary tract infection（UTI）and pneumaturia.Five patients（4/6）had a definite diagnosis by CT;2（2/6）by cystoscopy and 1（1/3）,by cystography.Among the 6 patients undergoing surgical intervention,resection of the involved bowl with one stage anastomosis and partial cystectomy was performed in 2;resection of the bowl with one stage anastomosis and repair of the fistulain 1;one—stage transverse colostomy and two stage radical colectomy with partial cystectomy in 2 and palliative proximal colostomy in 1.Results：One patient with palliative surgery died of tumor metastasis after operation 5 months.Five patients undergoing surgery had a better survival with no complication.Conclusions：The major cause of enterovesical fistula is intestinal malignancy.Recurent UTI and fecaluria are the most common symptoms.CT three-dimensional reconstruction is the prefered adjunctive examinations.Surgical intervention is the major therapeutic choice.