Management of ureterovaginal fistula following gynecological operations in single medical center
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摘要: 目的:探讨妇产科手术致输尿管阴道瘘的病因和特点,总结单中心输尿管损伤的诊治经验和措施。方法:对2008年1月~2016年1月在四川大学华西医院行妇产科手术所致的57例输尿管损伤患者的临床资料进行回顾性分析。观察指标包括手术时间、术后并发症等,随访患者的治疗效果。结果:50例(87.7%)行输尿管膀胱再植手术,其中开放手术42例,腹腔镜手术8例;7例(12.3%)行膀胱翻瓣输尿管成形术。平均手术时间为85(60~145)min。患者均无严重术后并发症,5例术后出现伤口感染。术后平均随访时间为3.5个月(1个月~3年),患者出院后1个月门诊复查肾功能和泌尿系B超。随访期间,所有患者通过影像学证实无输尿管瘘和输尿管狭窄征象。结论:妇产科手术致输尿管阴道瘘在女性泌尿道生殖瘘中呈逐渐上升趋势,其主要病因为妇科肿瘤行子宫全切术。CT尿路造影(CTU)能够快速而又准确地诊断输尿管损伤,尝试放置输尿管支架管失败后,早期输尿管膀胱再植仍是输尿管阴道瘘处理的最佳方式,腹腔镜输尿管膀胱再植术因创伤小、恢复快值得进一步推广。Abstract: Objective: To evaluate etiology and characteristics of ureterovaginal fistula, and to summarize the clinical experience of diagnosis and treatment for ureterovaginal fistula in single medical center.Method: From January 2008 to January 2016, 57 consecutive women with ureterovaginal fistula following gynecological operations were included. Collection of the data included operative time, pre- and post-operative complications. All data were recorded and analyzed by SPSS15.0 using statistical description.Result: Of these patients, 50 cases (87.7%) underwent ureteral reimplantation while the other 7(12.3%) underwent Boari-Ockerblad bladder flap for ureteroneocystostomy. For ureteral reimplantation, 42 cases underwent open surgery and 8 cases underwent laparoscopic surgery. The mean operation time was 85 (range, 60-145) min. There was no serious complication after surgery, but five cases were found surgical incision infection. Mean follow-up period was 3.5 (range, 1-36) months. Patients were followed up in outpatient clinic at one month. Blood urea nitrogen and serum creatinine were estimated and ultrasonography of the renal tract was carried out. No uretetral fistula or ureteral stricture was documented by imaging.Conclusion: The incidence of ureterovaginal fistula following gynecological operations is increasing, and the main etiology is hysterectomy for benign or malignant disease. The ureteral injury could be diagnosed promptly and accurately by CTU. When stent placement is unsuccessful, early ureteral reimplantation is the priority. The laparoscopic reimplantation could be recommended to patients because of less invasion and quickly recovery.
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