单层阴道环形皮瓣在经阴道修补膀胱阴道瘘中的临床应用

Clinical application of single-layer annular vaginal flap in transvaginal repair of vesicovaginal fistula

目的对比经阴道和经膀胱两种入路修补膀胱阴道瘘(Vesicovaginal fistula,VVF)的成功率及预后,重点探讨采用单层阴道环形皮瓣经阴道修补膀胱阴道瘘的技术特点和临床应用价值。方法回顾性分析2007年1月至2021年12月南京医科大学第一附属医院泌尿外科收治的57例采用经阴道和经膀胱两种入路修补VVF患者的临床资料,对比2组患者的一般信息、瘘的特点、手术资料、手术成功率以及术后并发症等情况。结果57例患者年龄27~75岁,平均50.4岁。病史7天~8年,平均20个月。主诉均为尿液经阴道漏出。56例(98.2%)VVF继发于妇科盆腔手术,1例(1.8%)继发于经阴道分娩(难产)。11例(19.3%)有既往手术修补失败史。57例手术均顺利完成,其中17例(29.8%)选择经阴道入路,40例(70.2%)选择经膀胱入路。平均手术时间:经阴道(90±8.2)min vs经膀胱(150±4.3)min;术中出血量:经阴道(40±5.4)ml vs经膀胱(220±10.2)ml;术后住院时间:经阴道(3±0.4)d vs经膀胱(7±1.2)d;平均住院费用:经阴道(1.3±0.2)万元vs经膀胱(2.5±0.5)万元。术中经阴道组无一例行膀胱造瘘,经膀胱组12例(30%)行膀胱造瘘。2组无一例发生严重并发症。轻度并发症发生率为经阴道组3例(17.6%)vs经膀胱组13例(32.5%)。随访时间为3~48个月,平均18.5月。一次性修补成功率分别为经阴道组82.3%vs经膀胱组75%。结论采用单层阴道环形皮瓣经阴道修补VVF,具有手术操作简便、并发症少、成功率高等优势,值得临床应用推广。

Objective To compare the success rate and prognosis of repairing vesicovaginal fistula(VVF)via transvaginal and transvesical approaches,and to highlight a modified transvaginal repair technique which only requires single layer closure of an annular vaginal flap.Methods A retrospective analysis was performed on 57 consecutive patients who underwent VVF repair between 2007 and 2021.Fistula characteristics,operative factors,post-surgical complications,and outcomes were analyzed.Results A total of 57 women with a median age of 50.4(range,27~75)years were included.The history ranged from 7 days to 8 years,with an average of 20 months.The chief complain was vaginal leakage of urine.Fifty-six(98.2%)cases of VVFs were caused by pelvic surgery,and only one resulted from difficult labour.Eleven(19.3%)cases had a history of surgical repair failure.All the 57 cases of surgery were smoothly completed.Among them,17 patients underwent transvaginal repair,whereas 40(70.2%)women had transvesical repair.Transvaginal approach had a significantly shorter operative time,less intraoperative blood loss,reduced postoperative hospital stay,less hospitalization cost,and lower minor complication rate than the transvesical group(P<0.05).No serious complications occurred in either group.No cystostomy was performed in the transvaginal group,but 12 cases(30%)in the transvesical group had cystostomy.The average follow-up time was 18.5(range,3~48)months.The first-time success rates of transvaginal and transvesical techniques were 82.3%and 75%,respectively.Conclusion VVF repair with single layer closure of an annular vaginal flap is a technically feasible,simple,and successful approach with significantly better operative parameters and lower complications rates.