经阴道拖出带蒂大网膜预防膀胱阴道残端瘘的临床效果观察

The clinical effects of preventing vesicovaginal fistula by dragging pedicled omentum through the vagina for patients after posterior pelvic exenteration

目的探讨后盆腔联合脏器切除术肝经阴道拖出带带大网膜预防膀胱阴道残端瘘的有效性和安全性。方法回顾2009年5月至2013年10月于本院行后盆腔联合脏器切除术的16例患者的临床资料,所有患者均为后盆腔联合脏器切除术后膀胱后壁因切除肿瘤肌层受损或溃破,均经阴道拖出带蒂大网膜预防膀胱阴道残端瘘。结果 16例患者中,15例术后7~14天拔除盆腔引流管,中位拔管时间为10天;术后14-30天拔除尿管,中位拔除尿管时间为20天。术后随访6个月,15例患者均未出现膀胱阴道残端瘘：另外1例患者术后20天拔除尿管,拔除尿管2天后出现膀胱阴道残端瘘,重新留置导尿管60余天后拔除,随访6个月未出现膀胱阴道残端瘘。结论经阴道拖出带蒂大网膜预防膀胱阴道残端瘘成功率高,术后并发症少,操作简单,值得推广。

Objective To investigate the safety and efficacy of preventing vesicovaginal fistula by dragging pedicled omentum through the vagina for the patients after posterior pelvic exenteration.Method A total of16 patients whose bladders were injured during the posterior pelvic exenteration in our hospital from May 2009 to October 2013 were retrospectively analyzed.The measure of preventing vesicovaginal fistula by dragging pedicled omentum through the vagina was applied to all the patients.Result The vesicovaginal fistula was not found in 15 cases during the 6 months follow-up：the median removal time of pelvic drainage tubes was 10 days（ranged 7~14 days）after operation：the median removal time of catheters was 20 days（ranged 14~30 days）.One patient suffered from the vesicovaginal fistula after pulling out catheter for 2 days（20 days after operation）,and the catheter was indelled again and pulled out after 60 days.There was no vesicovaginal fistula recurrence during the 6 months follow-up.Conclusion It is effective to prevent the vesicovaginal fistula for the patients after posterior pelvic exenteration by dragging pedicled omentum through the vagina.In addition,this treatment is worth promoting for fewer complications,simple operation and high success rate.