本文選題：膀胱陰道瘺 + 治療　； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的:比較不同手術(shù)術(shù)式治療膀胱陰道瘺的易行性及患者預(yù)后,評價(jià)電凝術(shù)用于小直徑膀胱陰道瘺治療的價(jià)值。方法:選擇北京大學(xué)人民醫(yī)院泌尿外科2008年10月至2016年11月收治并持續(xù)隨訪的膀胱陰道瘺患者資料進(jìn)行回顧性分析,共計(jì)19例,患者年齡31~55歲,中位年齡48歲;病程1~24個月,中位病程3個月,比較不同手術(shù)術(shù)式用于膀胱陰道瘺治療的瘺口情況和手術(shù)預(yù)后等是否存在差異。結(jié)果:3例行電凝術(shù),4例經(jīng)陰道修補(bǔ),7例開放腹腔切開膀胱前壁進(jìn)行修補(bǔ),5例進(jìn)行腹腔鏡修補(bǔ)。除1例患者拒絕留置尿管和D-J管外,其余患者術(shù)后常規(guī)留置尿管與雙側(cè)D-J管。68.2%的病例(13例)手術(shù)成功,術(shù)后未再發(fā)生陰道漏液。63.2%的病例(12例)手術(shù)一次成功,術(shù)后平均1.5個月完全恢復(fù)。3例行電凝術(shù)修復(fù)的患者,1例重復(fù)手術(shù)2次,術(shù)后1個月恢復(fù),另外2例均在術(shù)后1個月拔除尿管和D-J管后恢復(fù);4例經(jīng)陰道修補(bǔ)的患者,3例在術(shù)后1個月拔出尿管和D-J管后恢復(fù),1例術(shù)后恢復(fù)差;7例開放手術(shù)的患者中,5例手術(shù)效果好,術(shù)后恢復(fù)佳,1例轉(zhuǎn)外院繼續(xù)治療,1例于北京大學(xué)人民醫(yī)院進(jìn)行二次手術(shù),預(yù)后仍差;5例腹腔鏡修復(fù)的患者,3例一次手術(shù)成功,術(shù)后1個月拔管后痊愈,2例患者于外院進(jìn)行二次手術(shù),術(shù)后愈合差。電凝術(shù)用于治療膀胱陰道瘺,手術(shù)簡便易行,手術(shù)時(shí)間短,住院時(shí)間短,患者恢復(fù)佳。結(jié)論:電凝術(shù)創(chuàng)傷小,出血少,效果好;經(jīng)陰道修補(bǔ)適合瘺口位置低,利于暴露手術(shù)視野的病例;開放手術(shù)、腹腔鏡手術(shù)適合復(fù)雜性膀胱陰道瘺,尤其是需要同時(shí)處理輸尿管開口狹窄、輸尿管瘺等并發(fā)癥的病例,但手術(shù)時(shí)間長、出血多、創(chuàng)傷大,不利于術(shù)后恢復(fù)。對于單一瘺口、瘺口直徑小的膀胱陰道瘺推薦首選電凝術(shù)。
[Abstract]:Objective: to compare the feasibility and prognosis of different surgical procedures for vesicovaginal fistula and evaluate the value of electrocoagulation in the treatment of small diameter vesicovaginal fistula. Methods: the data of 19 patients with vesicovaginal fistula admitted from October 2008 to November 2016 in the Department of Urology, people's Hospital of Peking University were retrospectively analyzed. The patients aged 31 to 55 years with a median age of 48 years and the course of disease ranged from 1 to 24 months. The median course of 3 months was compared between different surgical procedures for the treatment of vesicovaginal fistula situation and surgical prognosis. Results 3 cases underwent electrocoagulation and 4 cases underwent vaginal repair. 7 cases were open abdominal cavity incision and 5 cases underwent laparoscopic repair. Except for one patient who refused to indwelling urethral catheter and D-J catheter, 13 cases (13 cases) with bilateral D-J tube and routine indwelling catheter were successfully operated on, and no vaginal leakage occurred in 12 cases (12 cases). The average recovery was 1.5 months after operation. 3 patients who underwent electrocoagulation repair had 2 repeated operations, and recovered 1 month after operation. In the other 2 cases, 4 patients recovered after the removal of urinary catheter and D-J tube, 3 patients recovered after 1 month of extraction of urinary catheter and 1 patient recovered after D-J tube, 5 of 7 patients with open operation had good results. After operation, 1 case of good recovery was transferred to other hospital and 1 case underwent second operation in the people's Hospital of Peking University. The prognosis was still poor in 5 cases of laparoscopic repair. 3 cases were successfully operated on at one time. One month after extubation, 2 patients were cured in the hospital, and the healing was poor. Electrocoagulation is used to treat vesicovaginal fistula. The operation is simple and easy, the operation time is short, the hospital stay is short, the patient recovers well. Conclusion: electrocoagulation has the advantages of less trauma, less bleeding and better effect. Transvaginal repair is suitable for cases with low fistula location and favorable exposure of surgical field of vision, open surgery and laparoscopic surgery are suitable for complicated vesicovaginal fistula. Especially, the complications of ureteral orifice stenosis and ureteral fistula need to be treated simultaneously, but the operation time is long, the bleeding is much and the trauma is great, which is not conducive to postoperative recovery. For single fistula, vesicovaginal fistula with small fistula diameter is recommended as the first choice of electrocoagulation.
【作者單位】： 北京大學(xué)人民醫(yī)院泌尿外科;
【分類號】：R699

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