膀胱肠瘘66例诊治分析

Diagnosis and treatment of 66 cases with vesicoenteric fistula

目的 探讨膀胱肠瘘的临床特点和诊治经验.方法 2012和2019年山西大同大学附属医院收治2例膀胱肠瘘患者,同时结合2001年9月至2018年12月中国期刊全文数据库收录发表的64例资料较完整的膀胱肠瘘患者进行回顾性研究.分析膀胱肠瘘的发病原因、临床表现、相关检查、治疗方法和预后,以探寻膀胱肠瘘的最佳诊疗方案.结果 66例患者中,男49例,女17例.发病原因有肠癌31例(46.97%),Crohn病11例(16.67%),结肠憩室炎10例(15.15%),膀胱癌8例(12.12%),阑尾炎及其他炎性疾病5例(7.58%),术中损伤1例(1.52%).主要临床表现有反复尿路感染 45 例(68.18%),粪尿 43 例(65.15%),腹痛 16 例(24.24%),气尿 16例(24.24%).41例行CT检查,确诊率为58.54%(24/41);47例行膀胱镜检查,确诊率为55.32% (26/47);34例行膀胱造影,确诊率为44.12%(15/34).60例(90.91%)行手术治疗,无围手术期死亡.28例患者有随访,平均随访4.1年,7例死于恶性肿瘤转移、复发;2例死于其他心脑血管等基础疾病;其余良性膀胱肠瘘患者随访期内无死亡.结论 膀胱肠瘘多继发于肠道肿瘤,具有典型的临床表现,影像学检查具有相对特征表现,CT、膀胱镜和膀胱造影是重要的确诊手段.手术是主要的治疗方法,预后多取决于原发疾病.

Objective To investigate the clinical characters and diagnosis and treatment in patients with vesicoenteric fistula. Methods Two patients with vesicoenteric fistula were admitted to the Affiliated Hospital of Shanxi Datong University in 2012 and 2019, at the same time 64 cases with complete data referenced from China Journal Full-text Database from September 2001 to December 2018 were retrospectively studied. The pathogeny, main clinical manifestations, relevant examination, treatment methods and prognosis were analyzed, to explore the best diagnosis and treatment of vesicoenteric fistula. Results Among all of 66 patients, there were 49 males and 17 females. The pathogeny included intestinal cancer in 31 cases (46.97% ), Crohn disease in 11 cases (16.67% ), intestinal diverticulitis in 10 cases (15.15%), bladder cancer in 8 cases (12.12%), appendicitis and other inflammatory diseases in 5 cases (7.58%) and intraoperative injury in 1 case (1.52%). The main clinical feature included recurrent urinary tract infection in 45 cases (68.18%), fecaluria in 43 cases (65.15%), abdominal pain in 16 cases (24.24%) and pneumaturia in 16 cases (24.24%). Forty-one cases underwent CT examination, and the diagnostic rate was 58.54% (24/41);47 cases underwent cystoscopy, and the diagnostic rate was 55.32% (26/47);34 cases underwent cystography, and the diagnostic rate was 44.12% (15/34). Six cases (90.91%) were treated with surgery, and no perioperative death occurred. Twenty-eight cases were followed up, and the mean follow-up time was 4.1 years. Seven cases died of tumor recurrence and metastasis;2 cases died of other basic diseases such as cardiovascular and cerebrovascular diseases. No other patients with benign vesicoenteric fistula died during follow-up. Conclusions The major cause of vesicoenteric fistula is intestinal malignancy, which shows emblematic clinical symptoms, and specific imaging characteristic. CT, cystoscopy and cystography are the main diagnostic technique. Surgical intervention is the major therapeutic choice, and the prognosis depends on the primary disease.