直肠癌患者术后尿瘘分型及早期治愈性手术的疗效

Early curative repair of urinary fistula caused by iatrogenic injury to ureter, bladder and urethra after resection of rectal cancer

目的探讨直肠癌患者术后尿瘘的类型及早期治愈性手术的可行性。方法回顾性分析2010年10月至2016年5月在河南省肿瘤医院普外科治疗的26例直肠癌术后尿瘘患者的临床资料，按照尿瘘发生的部位分4种类型，总结每种类型的治疗特点和转归。结果本组26例患者均在发现尿瘘的早期进行二次手术，其中Ⅰ型：后尿道瘘6例，行尿管支撑＋大网膜瘘口覆盖＋膀胱造瘘；Ⅱ型：膀胱底部瘘2例，行瘘口修补＋大网膜瘘口覆盖＋膀胱造瘘；Ⅲ型：膀胱三角瘘12例，行瘘口修补＋输尿管支架管置入＋输尿管再植＋大网膜瘘口覆盖＋膀胱造瘘：Ⅳ型：输尿管瘘6例。行输尿管支架管置入。治疗后26例患者修补成功24例，2例Ⅲ型患者行双侧输尿管皮肤永久造瘘术。结论针对不同类型直肠癌术后尿瘘患者，采用相应的方案进行早期治愈性手术是安全有效的。

Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter, bladder and urethra during resection of rectal cancer. Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery, Henan Tumor Hospital from October 2005 to May 2016. Urinary fistula was divided into four types according to the site of fistula. Results Surgery was performed ever after the diagnosis of the fistula was identified. In type Ⅰ fistula （6 cases of posterior urethral fistula） the treatment was stent placement and packing of the greater omentum. 2 cases of bladder top fistula （type Ⅱ ）, were treated by fistula repair and cystostomy. Type m involved 12 cases （bladder triangle fistula）. The treatment was ureter stenting replantation, and cystostomy Type IV： ureteral fistula in 6 cases, the treatment was end-to-end anastomosis and stenting. After surgery 24 cases were cured and 2 cases （ all of type Ⅲfistula） ended up with permanent bilateral ureterocutaneostomy. Conclusion It is safe and effective to make early remedy repair for ureter, bladder and urethral fistula iatrogenically during rectal cancer resection.