切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (07) : 636 -642. doi: 10.3877/cma.j.issn.1674-0785.2022.07.007

盆底疾病·临床研究

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
唐敏1, 李普1, 王成明1, 张倩1, 孟小鑫1,()   
  1. 1. 210029 南京,南京医科大学第一附属医院泌尿外科
  • 收稿日期:2022-03-08 出版日期:2022-07-15
  • 通信作者: 孟小鑫
  • 基金资助:
    江苏省卫生健康委医学科研面上项目(H2019041); 江苏省科协青年科技人才托举工程((2021)082号)

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

Min Tang1, Pu Li1, Chengming Wang1, Qian Zhang1, Xiaoxin Meng1,()   

  1. 1. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2022-03-08 Published:2022-07-15
  • Corresponding author: Xiaoxin Meng
引用本文:

唐敏, 李普, 王成明, 张倩, 孟小鑫. 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[J]. 中华临床医师杂志(电子版), 2022, 16(07): 636-642.

Min Tang, Pu Li, Chengming Wang, Qian Zhang, Xiaoxin Meng. Clinical application of single-layer annular vaginal flap in transvaginal repair of vesicovaginal fistula[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(07): 636-642.

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.

图1 改良的经阴道修补手术所用刀片。图中A为15号刀片;B为12号刀片。
图2 采用单层阴道环形皮瓣经阴道修补膀胱阴道瘘。图a为紧贴瘘口瘢痕边缘正常阴道壁上作环形切口。轮辐状潜行分离阴道壁全层1~2 cm,确保良好的阴道皮瓣血供,瘘口明显上移回缩;图b为以3-0微荞单层间断关闭阴道环形皮瓣。
表1 患者一般临床资料
表2 瘘的特征及手术资料
表3 手术结果和并发症情况
1
Hillary CJ, Osman NI, Hilton P, et al. The aetiology, treatment, and outcome of urogenital fistulae managed in well- and lower sourced countries: a systematic review [J]. Eur Urol, 2016, 70(3): 478-492.
2
Miller EA, Webster GD. Current management of vesicovaginal fistulae [J]. Curr Opin Urol, 2001, 11(4): 417-421.
3
Kidd LC, Lee M, Lee Z, et al. A multi-institutional experience with robotic vesico vaginal and uretero vaginal fistula repair after iatrogenic injury [J]. J Endourol, 2021, 35(11): 1659-1664.
4
Ghoniem GM, Warda HA. The management of genitourinary fistula in the third millennium [J]. Arab J Urol, 2014, 12(2): 97-105.
5
Farid FN, Azhar M, Samnani SS, et al. Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach [J]. J Coll Phys Surg Pak, 2013, 23(11): 828-829.
6
Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula [J]. Obstet Gynecol, 1988, 72(3): 313-319.
7
Oakley SH, Brown HW, Greer JA, et al. Management of vesicovaginal fistulae: a multicenter analysis from the fellows' pelvic research network [J]. Female Pelvic Med Reconstr Surg, 2014, 20(1): 7.
8
Gedik A, Deliktas H, Celik N, et al. Which surgical technique should be preferred to repair, benign primary vesicovaginal fifistulas? [J]. Urol J 2015, 12: 2422-2427.
9
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey [J]. Annals Surg, 2004, 240(2): 205.
10
Otsuka RA, Amaro JL, Tanaka MT, et al. Laparoscopic repair of vesicovaginal fistula [J]. J Endourol, 2008, 22(3): 525-527.
11
Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: case series of five patients [J]. Urology, 2006, 67(5): 970-973.
12
Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center [J]. Urol J, 2010, 7: 35-39
13
Malik MA, Sohail M, Malik MT, et al. Changing trends in the etiology and management of vesicovaginal fistula [J]. Int J Urol, 2018, 25(1): 25-29.
14
Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fifistula [J]. Crit Rev Oncol Hematol, 2003, 48: 295-304.
15
Latzko W. Postoperative vesicovaginal fistulas. Genesis and therapy [J]. Am J Surg, 1992, 48: 21.
16
Margolis T, Mercer LJ. Vesicovaginal fistula [J]. Obstet Gynecol Surv, 1994, 49: 840-847.
17
Kumar M, Agarwal S, Goel A, et al. Transvaginal repair of vesico vaginal fistula: a 10-year experience with analysis of factors affecting outcomes [J]. Urol Int, 2019, 103(2): 218-222.
18
Dwyer P, Kaplan F, Alvarez J. Transvaginal repair of vesicovaginal fistula: surgical techniques to improve access and successful vaginal closure [J]. Int Urogynecol J, 2013, 24(4): 531-532.
19
Luo DY, Shen H. Transvaginal repair of apical vesicovaginal fistula: a modified latzko technique-outcomes at a high-volume referral center [J]. Eur U, 2019, 76: 84-88.
20
酒育红, 于小瑞, 王升旗, 等. 单层或双层食管胃颈部吻合术治疗食管癌50例 [J]. 中国现代手术学杂志, 2011, 15(5): 360-361.
21
Kawai M, Yamaue H. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery [J]. Surg Today, 2010, 40(11): 1011-1017.
22
Gedik A, Deliktas H, Celik N, et al. Is percutaneous cystostomy always necessary in transvaginal repair of benign vesicovaginal fistulae? [J]. Int J Clin Exp Med, 2016, 9: 8755-8759.
[1] 张瑶, 张丹, 李燕东, 孟焱, 翟林. 经阴道超声检查对绝经后女性子宫内膜的评估价值[J]. 中华医学超声杂志(电子版), 2023, 20(03): 278-287.
[2] 李婷婷, 崔翔, 刘静, 吴鑫, 杨汐, 陈莉. 新型脐周按钮式切口在横向腹直肌肌瓣乳房重建中的应用[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 347-352.
[3] 仇申强, 王增涛, 郝丽文, 陈超, 刘林峰, 张迪. 拇手指全形再造二期整形的效果观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 485-490.
[4] 郝丽文, 王增涛, 荣凯, 侯致典, 陈超, 仇申强, 刘林峰, 张迪, 王云鹏, 钟硕. 趾增宽术在缺损手指全形再造中的应用效果观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 476-479.
[5] 陈永沛, 仲海燕, 陈勇, 王慜, 王倩, 邹鸣立, 袁斯明. 数字减影血管造影在腓动脉穿支皮瓣移植中的应用[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 507-510.
[6] 朴广昊, 李屹洲, 刘瑞, 赵建民, 王凌峰. 皮肤撕脱伤撕脱皮瓣活力早期评估与修复的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 528-532.
[7] 李硕, 尹希, 祁连港, 王丽, 刘宗宝. 浓缩生长因子在促进失神经皮瓣术后神经再生的应用前景[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 547-551.
[8] 张浩, 张万福, 韩飞, 佟琳, 王运帷, 李少辉, 陈阳, 曹鹏, 官浩. 游离组织瓣治疗无吻合血管或需困难吻合血管创面的临床进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 442-446.
[9] 吴萍, 刘永林, 陈能彬, 季明军, 万晓波. 应用皮瓣联合负压封闭引流及灌洗引流治疗胫骨骨折术后钢板外露的临床效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(04): 317-320.
[10] 刘江涛, 王一勇, 欧阳容兰, 黄书润. 采用改良胸脐带蒂皮瓣修复手腕背部深度创面的临床效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(04): 321-325.
[11] 王玲, 古兰. 对综合护理干预在小儿游离皮瓣移植术围手术期中应用效果的观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(04): 338-341.
[12] 张翼飞, 郭强, 赖华健, 钟文文, 叶雷, 马波, 瞿虎, 尧冰, 邱剑光, 王德娟. 加速康复外科在儿童尿道下裂围术期的应用效果分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 367-371.
[13] 赵宏霞, 刘静, 李晓薇, 陈金婵, 汪志霞. 腹腔镜下经阴道子宫全切术联合阴道前后壁修补术治疗老年子宫脱垂效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 561-565.
[14] 张继新, 胡军红, 谢爽, 武祖印, 张春旭. 经阴道单孔腹腔镜阑尾切除术可行性及近期疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 460-465.
[15] 王延召, 牛鹏飞, 丁长民, 高庆坤, 高兆亚, 安柯, 翟志超, 曾庆敏, 黄文生, 雷福明, 顾晋. 结直肠癌致腹壁巨大缺损的一期修补经验(附13例报告)[J]. 中华临床医师杂志(电子版), 2023, 17(05): 557-561.
阅读次数
全文


摘要