非抗反流型输尿管膀胱再植术在医源性输尿管阴道瘘中的应用--单中心经验

Application of ureteral replantation without anti-reflux technique in iatrogenic ure⁃terovaginal fistula-a report of single-center clinical experience

目的评价非抗反流型输尿管膀胱再植术治疗输尿管阴道瘘的有效性和安全性。方法收集2008—2018年于四川大学华西医院就诊的80例输尿管阴道瘘患者的临床资料,均使用非抗反流型输尿管膀胱再植术进行治疗,即直接行输尿管及膀胱黏膜对黏膜吻合,不使用额外的抗反流手术措施。术后3月进行随访,评估患者临床症状,行尿液分析、泌尿系统超声及排泄性膀胱尿道造影,判断手术效果。结果患者年龄(44.69±7.29)岁,体重指数22.56±2.49,术前漏尿时间(12.71±17.73)d。总体手术成功率为96.25%(77/80),所有患者未见明显膀胱输尿管反流。并发症包括6例轻度肾积水,3例复发性尿路感染,2例术后伤口感染,7例切口疼痛。结论在输尿管阴道瘘患者中,非抗反流型输尿管再植术是一类可靠、有效、且较为简单的手术方式,值得进一步推广。

Objective To analyze the efficacy and safety of ureteral replantation without anti-reflux technique in the treat⁃ment of vesicovaginal fistula.Methods Clinical data of 80 patients with ureterovaginal fistula treated during 2008 and 2018 were collected.All patients received ureteral replantation,which directly anastomosed the mucosa of the ureter and bladder with⁃out additional anti-reflux measures.A follow-up assessment of symptoms was performed 3 months later,including urine analy⁃sis,ultrasound of urinary system,intravenous pyelogram and voiding cystogram.Results The age of patients was(44.69±7.29)years,body mass index(BMI)was(22.56±2.49),and preoperative leakage time was(12.71±17.73)days.The overall surgical success rate was 96.25%(77/80),and no obvious vesicoureteral reflux was observed.Complications included mild hydronephrosis in 6 cases,recurrent urinary tract infection in 3 cases,wound infection in 2 cases,and incision pain in 7 cases.Conclusion In patients with ureterovaginal fistula,ureteral replantation without anti-reflux technique is a reliable,effective,and simple method,which is worthy of further promotion.