不同手术方式治疗膀胱阴道瘘

Different Surgical Methods for the Treatment of Vesicovaginal Fistula

目的:评价不同手术方式治疗膀胱阴道瘘的预后和价值。方法:回顾性分析笔者所在医院泌尿外科2013年1月-2018年12月收治的膀胱阴道瘘患者共计10例,患者年龄31~70岁,瘘口大小0.6~1.4 cm,病程3~12个月。评价不同膀胱阴道瘘瘘口情况对于手术方式的选择和手术预后的差异。结果:5例行腹腔镜经腹腔入路(膀胱外)修补,2例行开放膀胱切开修补,2例行腹腔镜经膀胱入路(腹膜外)修补,1例经阴道入路修补。80%的病例(8例)手术成功,术后未再发生阴道漏液。2例手术效果差,其中1例行腹腔镜经腹腔入路修补,1例开放膀胱切开修补,均改为开放手术经腹腔移植大网膜覆盖,术后效果佳。结论:腹腔镜经腹腔入路手术和开放手术适合应用于复杂性膀胱阴道瘘;经阴道入路修补适合瘘口位置较低、容易显露的病例;而对于较小瘘口单一的膀胱阴道瘘可选择腹腔镜经膀胱入路修补。

Objective:To evaluate the prognosis and value of different surgical methods for the treatment of vesicovaginal fistula.Method:A total of10 patients with vesicovaginal fistula admitted to our department of urology from January 2013 to December 2018 were retrospectively analyzed.The patients’ age ranged from 31 to 70 years,the size of the fistula was 0.6 to 1.4 cm,and the course of disease was 3 to 12 months.ALL the patients were to evaluate the prognosis and value of different surgical methods base on vesicovaginal fistulas.Result:5 cases underwent transperitoneal laparoscopic(extra-bladder)repair,2 cases underwent open bladder incision repair,2 cases underwent transvesical laparoscopic(peritoneal) repair,and 1 case underwent transvaginal repair.80% of the cases(8 cases) were successful,and there was no vaginal leakage after operation.Two cases had poor surgical results.One case underwent transperitoneal laparoscopic and the other underwent open bladder incision.All of them were changed to open surgery and covered with omental graft.The postoperative results were good.Conclusion:Open surgery,transperitoneal laparoscopic is suitable for cases with complicated vesicovaginal fistula.Transvaginal is suitable for cases with fistula in low position and easy to be seen.While transvesical laparoscopic is suitable for cases with small,single vaginal fistula.