膀胱阴道瘘漏尿后即时经阴道修补临床疗效研究

A clinical research of immediate transvaginal repair for urinary leakage due to vesicovaginal fistula

目的探讨妇产科手术损伤所致的膀胱阴道瘘在漏尿发生后即时施行经阴道修补手术的临床疗效。方法回顾性分析江西省人民医院妇科2011年3月至2019年6月收治的因妇产科手术损伤所致的膀胱阴道瘘并接受经阴道修补手术的53例患者资料,按修补手术距漏尿发生的时间分为2组。其中,研究组28例,于漏尿发生并确诊膀胱阴道瘘后,不等待观察,而是立即施行修补手术;对照组25例,于漏尿发生并确诊膀胱阴道瘘后,观察等待3个月或以上时间,再施行修补手术。结果53例中,一次修补成功51例,术后随访3个月未复发,研究组与对照组各有1例经二次修补成功。两组的修补成功率(96.4%vs.96.0%),P=1.000;术中出血量(53.0±17.7)mL vs.(49.4±10.8)mL,P=0.384;手术时间(69.2±10.7)min vs.(63.2±13.0)min,P=0.071;术后最高体温(37.8±0.6)℃vs.(37.7±0.7)℃,P=0.637;术后发热天数(1.9±0.9)d vs.(1.7±0.9)d,P=0.587;住院天数(16.7±1.8)d vs.(15.9±1.7)d,P=0.106;术后尿路感染(3 vs.2,P=1.000)、肠管损伤(0 vs.0)、继发阴道狭窄(0 vs.0)的差异均无统计学意义。结论对于妇产科手术损伤所致的膀胱阴道瘘,在漏尿发生后可立即施行经阴道修补手术,无需等待3个月或以上。经阴道膀胱阴道瘘修补手术,利用人体自然腔道,更微创,易被患者接受。

ObjectiveTo discuss the clinical efficacy of immediate transvaginal repair for urinary leakage due tovesicovaginal fistula caused by surgical injury in obstetrics and gynecology.MethodsA retrospective analysis wasmade on 53 patients with vesicovaginal fistula caused by gynecological and obstetric surgical injuries who receivedtransvaginal repair in Jiangxi Provincial People’s Hospital from March 2011 to June 2019.They were divided into twogroups according to the timing of repair operation:28 cases in the study group were treated immediately after urinaryleakage and diagnosis of vesicovaginal fistula,without waiting for observation;25 cases in the control group wereobserved for over 3 months after urinary leakage and diagnosis of vesicovaginal fistula and then received the repair.ResultsAmong the 53 cases,51 cases were successfully repaired at one time,and no recurrence occurred during thethree-month follow-up;one case in each group was successfully repaired in the second operation;no significantdifferences were noted in the efficacy or complications between the two groups.The success rates of the two groups were(96.4%vs.96.0%,P=1.000);the amount of bleeding during operation was(53.0±17.7)m L vs.(49.4±10.8)m L,P=0.384;the time of operation was(69.2±10.7)min vs.(63.2±13.0)min,P=0.071;the highest body temperature afteroperation was(37.8±0.6)℃vs.(37.7±0.7)℃,P=0.637;the fever days after operation were(1.9±0.9)d vs.(1.7±0.9)d,P=0.587;the days of hospitalization were(16.7±1.8)d vs.(15.9±1.7)d,P=0.106.There was urinary tract infection(3 vs.2,P=1.000),intestinal injury 0 vs.0,secondary vaginal stricture 0 vs.0.None of the above indexes were statisticallydifferent between the two groups.ConclusionFor vesicovaginal fistula caused by gynecological and obstetric operationinjury,transvaginal repair can be performed immediately after urine leakage,abd it’s unnecessary to wait for threemonths or more.Transvaginal vesicovaginal fistula repair surgery,through the human body’s natural cavity,is more minimally invasive and easy to be accepted by patients.