医源性泌尿生殖道瘘及损伤的单中心10年数据分析并文献复习

张月婷; 沈宏; 陈悦悦; 牛晓宇

doi:10.13201/j.issn.1001-1420.2019.06.003

医源性泌尿生殖道瘘及损伤的单中心10年数据分析并文献复习

- 1. 四川大学华西第二医院妇产科出生缺陷与相关妇儿疾病教育部重点实验室(四川大学)(成都, 614000);
- 2. 四川大学华西医院泌尿外科

详细信息

通讯作者: 牛晓宇,E-mail:2729493428@qq.com

中图分类号: R695.1

收稿日期: 2019-03-29

Iatrogenic urogenital fistula and injury in single medical center: 10-year data analysis and literature review

- 1. Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, 610041, China;
- 2. Department of Urology, West China Hospital, Sichuan University

More Information

Corresponding author: NIU Xiaoyu, E-mail: 2729493428@qq.com

Received Date: 29 March 2019

摘要

摘要: 目的:探讨医源性泌尿生殖道瘘的发病率、原因及诊治,为减少医源性泌尿生殖道瘘提供策略分析。方法:回顾性分析2009年3月~2019年3月在我院行妇产科手术发生泌尿生殖道瘘及损伤(包括膀胱阴道瘘、输尿管阴道瘘、膀胱子宫瘘、膀胱及输尿管破裂)的65例患者的临床资料,收集患者术前诊断、手术方式、损伤原因及发现时间、治疗方法等。结果:妇科手术50例(76.92%),其中良性疾病18例,恶性肿瘤27例,生殖道畸形3例,切口妊娠及切口憩室2例;产科手术15例(23.08%),其中瘢痕子宫10例,非瘢痕子宫4例,盆腔结核病史1例。术中发现泌尿系统损伤29例(44.62%),术后发现36例瘘(55.38%)。输尿管阴道瘘30例(46.15%),行膀胱输尿管再植术23例(76.67%)、经尿道输尿管支架置入术2例(6.67%)、输尿管修补术2例(6.67%)、失访3例(10.00%);膀胱破裂27例(41.54%),均行膀胱修补术;膀胱阴道瘘5例(7.69%),行经阴道膀胱瘘修补术4例(80.00%)、经腹膀胱修补术1例(20.00%);膀胱子宫瘘1例(1.54%),行经腹膀胱修补术;膀胱瘘+双侧输尿管瘘1例(1.54%),行膀胱阴道瘘修补术;术中输尿管破裂1例(1.54%),行输尿管膀胱再植术。除失访患者3例,其余62例患者均一期治愈。结论:妇科手术所致泌尿生殖道瘘中,困难的全子宫切除术是主要危险因素;产科高危因素系前次盆腔手术史导致膀胱粘连。膀胱损伤多于术中发现并修补,术后发生的膀胱阴道瘘以留置尿管延期行经阴道膀胱修补术为适宜方案;输尿管损伤多于术后发现,输尿管膀胱再植术是输尿管阴道瘘多数选择。医源性泌尿生殖道瘘可以通过提高术者操作技能及防范意识等措施预防及减少。
- 泌尿生殖道瘘 /
- 医源性泌尿系统损伤 /
- 妇产科手术
Abstract: Objective: To evaluate the incidence, etiology and diagnosis of iatrogenic urogenital fistula, and to provide strategic analysis for reducing the incidence of iatrogenic urogenital fistula. Method: We conducted a retrospective single center study. From March 2009 to March 2019, 65 patients with urogenital fistula and injury following gynecologic and obstetric surgeries were evaluated by collecting data of pre-operative diagnosis, pre-and post-operative complications, cause and onset of urogenital injury and management. Result: Of these patients, 50 cases (76.92%) underwent gynecologic surgery while the other 15 (23.08%) underwent obstetric surgery. For gynecologic surgery, 18 cases were diagnosed benign diseases, 27 cases were diagnosed malignant diseases, 3 cases were genital malformation and 2 were cesarean scar pregnancy and diverticulum. For obstetric surgery, 10 cases were scarred uterus, 4 cases were not scarred uterus and the other 1 had a history of pelvic tuberculosis. As to the onset of injury, 29 cases (44.62%) were intraoparatively diagonosed and the other 36 (55.38%) were postoperatively diagnosed. Of these 65 patients, 30 cases (46.15%) were diagnosed ureterovaginal fistula, 23 cases (76.67%) of them underwent ureteral reimplantation, 2 cases (6.67%) of them underwent transurethral stent placement, 2 cases (6.67%) of them underwent ureteral repair surgery and 3 cases (10.00%) were lost for follow-up; 27 cases (41.54%) were diagnosed cystorrhexis and they all underwent bladder repair; 5 cases (7.69%) were diagnosed vesicovaginal fistula, 4 cases (80.00%) of them underwent transvaginal bladder repair, 1 cases (20.00%) underwent transabdominal bladder repair; 1 case (1.54%) was diagnosed vesicouterine fistula and underwent transabdominal bladder repair; 1 case (1.54%) was diagnosed vesicovaginal and ureterovaginal fistula and the treatment was bladder repair; 1 case (1.54%) was diagnosed ureterodialysis and underwent ureteral reimplantation. Of all these cases, 3 cases were lost for follow-up, while the other 62 cases were cured.Conclusion: Difficult hysterectomy is the main risk factor for urogenital fistula caused by gynecologic surgery. Obstetric risk factors were related to bladder adhesion caused by previous pelvic surgery. Bladder injury is likely to be found and repaired intraoperatively, delayed transvaginal bladder repair with indwelling catheter is the best option for postoperative vesicovaginal fistula; ureter injury is more likely to be found after surgery, ureteral reimplantation is the most choice for ureterovaginal fistula. Iatrogenic urogenital fistula can be prevented and reduced by improving operators' operation skills and awareness.
- urogenital fistula /
- iatrogenic urinary injury /
- gynecologic and obstetric surgeries

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