妇科术后并发膀胱阴道瘘的治疗体会

Experiences in treatment of vesicovaginal fistula after gynecological surgery

目的:探讨妇科术后并发膀胱阴道瘘的治疗体会。方法:选取就诊于广东省人民医院、妇科术后并发膀胱阴道瘘的患者48例,根据手术治疗方法分为经阴道治疗组和经腹部治疗组,每组24例。经阴道治疗组的患者采取经阴道修补术治疗,经腹部治疗组的患者采取经腹部修补术治疗。观察术中及术后各指标,总结治疗经验。结果:经阴道治疗组中,10例(41.67%)采用腹腔镜下子宫切除术、9例(37.50%)采用腹式全子宫切除术、5例(20.83%)采用广泛全子宫切除术后并发膀胱阴道瘘。经腹部治疗组中,12例(50.00%)采用腹腔镜下子宫切除术、10例(41.76%)采用腹式全子宫切除术、2例(8.33%)采用广泛全子宫切除术后并发膀胱阴道瘘。两组患者的手术时间和一次性成功率比较差异均无统计学意义(P>0.05),经阴道治疗组住院时间为(13.67±2.30)天、轻度尿失禁发生率为4.17%,均低于经腹部治疗组[(19.24±1.90)天和16.67%],差异均有统计学意义(P<0.05)。结论:经阴道修补法治疗妇科术后并发膀胱阴道瘘操作简单、术后不良反应发生率低、恢复快,值得临床推广应用。

Objective： To explore the experiences in treatment of vesicovaginal fistula after gynecological surgery. Methods：Forty- eight patients with vesicovaginal fistula after gynecological surgery were selected from this hospital and divided into transvaginal treatment group and transabdominal treatment group,24 patients in each group. The patients in transvaginal treatment group were treated with transvaginal repair surgery,while the patients in transabdominal treatment group were treated with transabdominal repair surgery. The intraoperative and postoperative indexes were observed,the experiences of treatment were summarized. Results： In transvaginal treatment group,vesicovaginal fistula occurred in ten patients（ 41. 67%） after laparoscopic hysterectomy,nine patients（ 37. 50%） after transabdominal hysterectomy and five patients（ 20. 83%） after radical hysterectomy. In transabdominal treatment group,vesicovaginal fistula occurred in twelve patients（ 50. 00%） after laparoscopic hysterectomy,ten patients（ 41. 76%） after transabdominal hysterectomy and two patients（ 8. 33%）after radical hysterectomy. There was no statistically significant difference in the operation time and the one- time successful rate between the two groups（ P〉0. 05）,the hospitalization time and the incidence rate of mild urinary incontinence in transvaginal treatment group were（ 13. 67 ± 2. 30） days and 4. 17%,respectively,which were statistically significantly lower than those in transabdominal treatment group[（ 19. 24 ± 1. 90） days and 16. 67% ]（ P〈0. 05）. Conclusion： Transvaginal repair surgery is simple in treatment of vesicovaginal fistula,which has the advantages of low incidence rate of adverse reactions and rapid recovery,the method is worthy of clinical popularization and application.