妊娠合并先天性膀胱阴道瘘1例报告

One case of pregnancy and congenital vesicovaginal fistula

探讨先天性膀胱阴道瘘(congenital vesicovaginal fistula)的诊断及治疗方法。回顾性分析1例妊娠合并先天性膀胱阴道瘘患者的临床资料,分析其发生原因,并结合国内外文献对其临床诊断与处理进行探讨。先天性膀胱阴道瘘是一种罕见的泌尿生殖系畸形,具有自幼阴道漏尿、周期性血尿和腹痛的临床特点,常伴有其他泌尿系畸形及继发尿路感染和泌尿系统结石形成。发病原因与遗传、环境、药物、接触放射线等有关,或苗勒氏管融合不全所致。诊断主要依靠临床表现及影像学检查。治疗原则是手术恢复尿路的完整性。先天性膀胱阴道瘘合并妊娠罕见,临床容易误诊,早期诊断,准确判断病变的位置、大小、类型及与周围组织的关系,明确是否存在其他泌尿生殖器畸形,做好充分的术前准备,制定合理的手术方案及规范的术后护理是提高手术成功率的关键。

To discuss the dignosis and therapy of congenital vesicovaginal fistula （VVF）. We reported 1 case of pregnancy and congenital VVF and summarized the pathogenesis and characters. Congenital VVF is extremely rare and characterised by continuous urinary leakage, cyclical hematuria with severe suprapubic pain. It is always associated with other urinary tract abnormalities, urinary tract infection and stone. The pathogenesis is related with genetic, environment, drugs, radiation and incomplete fusion of mullerian. The diagnosis relies on clinical manifestasion and radiological examinations. Surgical recection is the key to treatment. Pregnancy and congenital VVF is extremely rare and always misdiagnosised associated with other urinary tract abnormalities. Early diagnosis and making sure the location, size and relationship with other tissues are important. Reasonable preoperative preparation, surgical and postoperative surgical care are the key for treatment.