腹腔镜下大网膜移位修补膀胱阴道瘘16例报告

Laparoscopic repair of vesicovaginal fistula with great omentum shift （ reports of 16 cases）

目的探讨腹腔镜下大网膜移位修补膀胱阴道瘘的可行性及效果。方法回顾性分析2007年7月至2011年7月收治16例膀胱阴道瘘患者的资料。年龄34-72岁，平均48岁。病史1个月-30年，其中子宫术后并发症15例，节育环穿孔所致1例。16例均为单个瘘口，瘘口直径〈1cm者13例，〉1em者3例。瘘口位于阴道壁14例，位于宫颈处2例。16例均行经腹腔路径腹腔镜下大网膜移位局部填塞＋常规膀胱阴道瘘分层缝合修补瘘口。结果16例手术均获成功，手术时间120-175min，平均150min；术中出血量50-300ml，平均120ml；术后住院6-10d，平均8．5d；尿管留置14-21d，平均17d。无肠道损伤等严重并发症。术后随访3-45个月，平均23个月。治愈14例，好转1例，失败1例。结论腹腔镜下大网膜移位修补膀胱阴道瘘具有损伤小、痛苦轻、效果较肯定等特点，大网膜局部填塞和精细的分层缝合是手术要点。

Objective To evaluate the feasibility and efficacy of laparoscopic repair of vesicovaginal fistula （VVF） with omentum shift. Methods Sixteen VVF patients were reviewed retrospectively from July 2007 to July 2011, aged from 34 to 72 years with a mean age of 48 years. The history of leakage of u- rine ranged from 1 month to 30 years, of which 15 cases due to uterine operation complication and 1 case due to IUD perforation. All cases were single fistula, with the fistula diameter 〈 1 cm in 13 cases and 〉 1 cm in 3 cases. Fourteen cases of fistulas were in the vaginal wall, and 2 cases were in the cervix. Surgical tech- niques were transabdominal laparoscopie local displacement of the great omentum and conventional layered suture repair of vesicovaginal fistula. Results All surgeries were successful. The operation time was 120 - 175 min, with an average of 150 min. The blood loss was 50 -300 ml, with an average of 120 ml. The postoperative hospital stay was 6 to 10 d, with an average of 8.5 d. The catheter indwelling time was 14 to 21 d, with an average of 17 d. During the period of follow-up for 3 to 45 months with an average of 23 months, 14 cases cured, 1 case improved and 1 case failed. No major complications such as intestinal injury occurred. Conclusions Laparoscopic repair of VVF with great omentum shift has the characteristics of less damage, less pain and positive effect. The key points of the surgery are local filling of great omentum and delicate layered suture.