经腹径路手术治疗膀胱阴道瘘的临床分析

Clinical analysis of transabdominal vesicovaginal fistula repair

目的:探讨经腹径路手术治疗膀胱阴道瘘的临床疗效。方法:回顾性分析14例女性膀胱阴道瘘患者资料。患者平均年龄41.36岁。临床表现不同程度阴道漏尿,或伴血尿及膀胱刺激症状。膀胱镜检、膀胱尿道造影及CT三维重建术前确诊。先后行经腹径路膀胱阴道瘘修复手术,其中采取经膀胱径路9例,膀胱外径路5例。结果:14例术后随访9～103个月,平均46.26个月。2例术后出现再次膀胱阴道瘘,行二次修补手术后未再复发,1例出现切口感染,经对症处理后愈合,其余患者均未出现尿瘘复发及其他严重并发症。结论:经腹径路手术治疗膀胱阴道瘘,术中视野暴露充分,易于获取带蒂支持组织,尤其对于复杂性膀胱阴道瘘及合并输尿管等组织损伤可疑患者,是一种可行的手术治疗方式。

Objective：To investigate the clinical efficacy of transperitoneal surgical treatment of vesicovaginal fistulas. Method：The clinical date and therapy procedure of 14 eases of vesicovaginal fistulas （all females, average age 41.36） were retrospectively analysed. Patients presented with leakage of urine from the vagina, accompanied by hematuria and bladder irritability or not. Preoperative evaluations included cystoscopy, antegrade/retrograde cystography, and spiral CT 3 dimension reconstruction. Transperitoneal vesicovaginal fistula repair was performed in all 14 cases, transvesical approach in 9 and extravesical approach in 5. Result：The patients were followed for 9- 103 months （mean, 46. 26 months） postoperatively. Recurrent vesicovaginal fistula developed in two patient, which was cured after a second attempt, an abdominal wound infection developed in one, and got better after re- ceiving a broad-spectrum intravenous antibiotic and regular dressing change. The remaining repairs were successful without severe complications. Conclusion： Transperitoneai vesicovaginal fistula repair offers an opportunity for wide exploration and the use of a peritoneal or omental flap, which is an available selection especially for the com- plex fistulas and fistulas associated with suspected intraabdominal pathology.