115例膀胱阴道瘘的单中心临床经验

Clinical Experience of Vesicovaginal Fistula(Report of 115 Cases)

目的分析膀胱阴道瘘的病因、手术治疗效果及影响因素,总结手术时机、手术关键、围手术期处理要点及预防措施。方法回顾性分析昆明医科大学第二附属医院泌尿外科2003年1月至2019年3月收治的115例膀胱阴道瘘患者的临床资料,包括致瘘原因、手术方式、手术时机及疗效、围手术期处理等。115例患者中,经腹开放手术63例,经腹腹腔镜手术18例,经阴道手术34例。12例早期(漏尿病程<3个月,发现即手术)手术,103例延期(漏尿病程≥3个月)手术。13例利用周围组织进行修补,包括带蒂大网膜及大小阴唇之间的组织覆盖瘘口、膀胱组织瓣替代等。随访3月、6月,包括是否漏尿及生活质量改变情况。结果 107例(107/115,93.0%)继发于手术损伤;经腹开放手术、经腹腹腔镜手术和经阴道手术修补成功率分别为90.5%(57/63)、94.4%(17/18)和85.3%(29/34),差异无统计学意义(P=0.555)。早期和延期手术修补成功率分别为83.3%(10/12)和90.3%(93/103),差异无统计学意义(P=0.805)。利用周围组织进行修补者均一次手术成功。修补成功者随访期间无漏尿,生活质量模型改善,与术前比较,差异有统计学意义。结论手术损伤是当前发生膀胱阴道瘘的主要原因,手术途径的选择取决于术者的经验及患者的具体情况,条件适宜者可早期修补,适当利用周围组织可提高手术修补成功率。

Objective To explore the etiology and effects of surgery for vesicovaginal fistula,to summarize the the chance of surgery, the keys of surgery, the keys of perioperative measurement and the preventive measures. Methods Data of 115 patients with vesicovaginal fistula who were admitted into the Second Affiliated Hospital of Kunming Medical University from January 2003 to March 2019,were analyzed retrospectively,including the causes of fistula, surgery methods, surgery timing, perioperative treatments and clincal outcomes. Among 115 cases, 63 cases were treated with transabdominal open surgery,18 cases with laparoscopic surgery,and 34 cases with transvaginal surgery. Twelve patients received early (less than 3 months) surgery and 103 patients received delayed (more than 3 months) surgery. The adjacent tissue was used to repair the fistula in 13 cases, including pedicled omentum, bladder valve and the tissue between labia majora and labia minora. Patients were followed up for 3 months and 6 months after the surgery, including urinary leakage and quality of life. Results postsurgical injuries occured in 107(107/115, 93.0%) cases. The success rates of transabdominal open surgery, transabdominal laparoscopic surgery and transvaginal surgery were 90.5%,94.4% and 85.3% respectively, which showed no significant difference (P = 0.555). The early and delayed operation repair showed no significant difference in the regard of success rates (83.3% vs. 90.3%,P = 0.805). Patients with adjacent tissue repair achieved total success in all the 13 cases. During the following-up, those who received succeessful repair did not suffer from any urine leakage and the quality of life was improved. The differences before and after the operation were statistical significant. Conclusion Surgical injury is the main cause of bladder-vagina fistula at present. The choice of surgical approach depends on the experience of the surgeon and the specific conditions of the patients. Early repair is suggested if conditions are appropriate,and the appropriate use of surrounding tissues can improve the success rate of surgical repair.