膀胱全厚肌瓣技术在机器人辅助腹腔镜膀胱阴道瘘修补中的应用

Clinical application of full-thickness bladder muscle flap in robotic assisted laparoscopic repair of vesicovaginal fistula

目的:探讨膀胱全厚肌瓣技术应用于机器人辅助腹腔镜膀胱阴道瘘(VVF)修补术中的可行性和有效性。方法:2016年10月～2017年9月对6例复杂性VVF患者实施机器人辅助腹腔镜下修补术,术中取膀胱全厚自体肌瓣填塞固定于膀胱后壁和阴道瘘口之间,记录手术过程并观察其临床效果。结果:6例手术均成功,无中转开放,未见脏器副损伤。VVF瘘口直径1.5～3.0cm,平均(2.1±0.6)cm。平均手术时间(82.6±11.3)min,出血量(42.8±13.5)ml。裁取的膀胱全厚肌瓣平均长度(4.1±0.8)cm,宽度(2.6±0.3)cm。术后恢复顺利,无腹、盆腔或泌尿生殖道感染,拔除尿管后无即刻膀胱阴道漏尿发生。平均随访19个月,1例不全性肠梗阻经保守治疗好转,无VVF症状复发。结论:机器人辅助腹腔镜VVF修补+膀胱全厚肌瓣填塞固定技术治疗复杂性VVF的可操作性强,安全性好,疗效可靠。

Objective:To evaluate the feasibility and effectiveness of bladder full-thickness muscle flap in robot-assisted laparoscopic repair of vesicovaginal fistula(VVF).Method:From Oct.2016 to Sep 2017,a total of 6 cases with complicated VVF were treated with robot-assisted laparoscopic VVF repair.The full thickness autologous flap of the bladder was obtained and fixed between the posterior wall of the bladder and the vaginal fistula,then the clinical efficacy was observed.Result:All the 6 cases were successfully operated without conversion to open surgery or secondary organ injury.The diameter of fistula orifice was 1.5-3.0 cm with an average of(2.1±0.6)cm.The mean operative time was(82.6±11.3)min and the blood loss was(42.8±13.5)ml.The mean length and width of the full-thickness bladder muscle flap that obtained was(4.1±0.8)cm and(2.6±0.3)cm respectively.All patients recovered successfully without pelvic or urogenital tract infection,and no immediate bladder or vagina leakage occurred after the removal of the catheter.During an average follow-up period of 19 months,there was only one case of incomplete intestinal obstruction who was improved by conservative treatment without recurrence of VVF symptoms.Conclusion:The clinical application of bladder full thickness muscle flap packing fixation in robot-assisted laparoscopic technology for the repairment of complicated VVF is safe,operable and reliable.