医源性输尿管阴道瘘16例诊治分析

Analyse on Diagnosis and Treatment for 16 Cases of Iatrogenic Ureterovaginal Fistula

目的探讨医源性输尿管阴道瘘的诊断、治疗方法与手术时机。方法回顾性分析2000—2009年本院诊治的16例输尿管阴道瘘患者的临床资料。检查手段包括B超、静脉尿路造影（IVU）、美蓝试验、膀胱镜检及逆行肾盂造影。14例（87.5%）患者先尝试早期输尿管镜下放置双J管术,置管失败与病史较长者改行输尿管膀胱再植术（包括膀胱壁肌瓣输尿管吻合术）。结果 16例患者中,7例（43.7%）通过成功置双J管获得治愈;7例镜下置管失败患者改行输尿管膀胱再植术获得治愈;2例漏尿病史超过3个月者直接行输尿管膀胱再植术获得治愈。随访6~33个月（平均10.5个月）,所有患者均无阴道漏尿。结论早期处理输尿管阴道瘘是可行的,输尿管镜下置入双J管术安全、有效,是首选治疗方法,失败后可再选择行输尿管膀胱再植术。

Objective To discuss the diagnosis,treatment and timing of operation of ureterovaginal fistula. Methods A retrospetive analysis of clinical data of 16 cases with ureterovaginal fistula in our hospital from the year of 2000 to 2009 was performed.B-ultrasound,intravenous urography（IVU）,dye test,cystoscopy and retrograde pyelography were used to diagnose.Fourteen cases（87.5%） were firstly tried to treat with placing double J-stent by using a ureteroscope.The failed cases with double J-stent placement or patients with longer history received ureteroeystostomy（including boari flap ureteroplasty）. Results Seven cases were successfully cured by using ureteroscope to insert double J-stent.Seven cases were successfully treated by performing ureterocystostomy after the failure of inserting double J-stent.Two cases over 3 months＇ history receving ureterocystostomy recoverd very well.The follow-up from 6 months to 33 months（average 10.5 months） showed that all of the 16 cases had been cured and had no urinary fistula. Conclusion Early treatment of ureterovaginal fistula is feasible.Inserting double J-stent to ureter by ureteroscope is effective and safe,which may be the fist choice of the therapy.If it fails,ureteroeystostomy is the second choice.