窦道刮除+窦口黏膜电灼术治疗早期膀胱阴道瘘

Sinus curettage and mucous membrane fulguration in the treatment of early vesicovaginal fistula

目的探讨窦道刮除+窦口黏膜电灼术对早期膀胱阴道瘘的临床疗效。方法本组5例女性患者,分别为剖宫产术后1例、子宫肌瘤剥除术后2例、子宫全切术后2例,术后拔除导尿管后均有液体自阴道不自主流出,术前经膀胱尿道镜检查及阴道美蓝试验确诊膀胱阴道瘘,均为单一瘘口,膀胱尿道镜下瘘孔直径0.5~1.0cm,术前3d清洗阴道并排除泌尿系及会阴部感染,5例随即在腰硬联合麻醉下行膀胱阴道瘘窦道刮除+窦口黏膜电灼术,其中1例二次行窦口黏膜电灼术,术后均给予敏感抗生素3d,留置尿管2周。结果手术时间约为30~60min,平均45min。术中出血平均10mL。围手术期未见重大并发症。4例术后无阴道漏尿;1例阴道漏尿症状明显减轻,二次行窦口黏膜电灼术,术后无阴道漏尿症状发生。随访12个月无复发。结论窦道刮除+窦口黏膜电灼术治疗早期膀胱阴道瘘,具有创伤小、简单易行等特点,可在早期进行,疗效确切。

Objective To explore the efficacy of snus curettage and mucous membrane fulguration in the treatment of early vesicovaginal fistula. Methods The clinical data of 5 cases of early vesicovaginal fistula were reviewed,including 1 case of caesarean section,2 cases of myomectomy and 2 cases of total hysterectomy. In all cases,when the catheter was removed, there was liquid outflowing spontaneously from the vagina. Cystourethroscopy and Meilan test confirmed that all cases were sin- gle vesicovaginal fistula with diameter of 0.5 to 1 cm. The vagina was cleaned 3 days before operation to make sure there was no urinary or vulvar infection. After that, the sinus curettage and mucous membrane fulguration was performed in all cases. One case needed a second session. After operation, antibiotics were administered for 3 days, and catheter was indwelt for 2 weeks. Results The operation time ranged from 30 to 60 rain （mean 45 min）. The average intraoperative blood loss was 10 mE. No serious perioperative complication was observed. Urinary fistula was cured in all cases. During the follow-up of 12 months, no re-lapse occurred. Conclusion Sinus curettage and mucous membrane fulguration is a simple,safe and effective way in the treat-ment of early vesicovaginal fistula.