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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/OL]. 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/OL]. 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
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