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目的探讨膀胱肠瘘的诊断与治疗方法。方法回顾性分析12例膀胱肠瘘患者的临床资料。男10例,女2例。平均年龄57岁。膀胱回肠瘘3例、膀胱结肠瘘7例、膀胱直肠瘘2例。病因为肠道恶性肿瘤7例、Crohn病3例、膀胱癌和肠道憩室炎各1例。临床表现粪尿10例、反复尿路感染6例、腹痛4例、气尿3例。CT确诊5例(5/9)、膀胱镜确诊3例(3/6)、膀胱造影确诊2例(2/ 5)、钡剂灌肠确诊1例(1/5)。行手术治疗10例,其中病变肠段切除一期吻合加膀胱部分切除术4例,病变肠段切除一期吻合加瘘修补术或单纯膀胱引流术各1例,一期横结肠造口、二期结肠癌根治加膀胱部分切除术1例,姑息性近端结肠造口术3例。保守治疗2例。结果1例于入院后第10天死于感染性休克。9例随访3个月～16年,平均6．5年。肠瘘1例复发,再次手术后治愈；1例保守治疗者及1例姑息性手术者死于肿瘤转移,1例术后2年死于脑血管意外,此前随访肠瘘无复发；余5例手术治疗者生存良好,无明显术后并发症。结论膀胱肠瘘多继发于肠道恶性肿瘤,主要临床表现为粪尿和反复尿路感染,CT和膀胱镜为首选的检查方法,治疗以手术为主。
Objective To investigate the diagnosis and treatment of bladder intestinal fistula. Methods Retrospective analysis of 12 cases of intestinal fistula clinical data. 10 males and 2 females. Average age 57 years old. Bladder ileus fistula in 3 cases, Bladder fistula in 7 cases, Bladder rectum fistula in 2 cases. 7 cases of intestinal malignancies, Crohn’s disease in 3 cases, bladder cancer and intestinal diverticulitis in 1 case. Clinical manifestations of excretion in 10 cases, recurrent urinary tract infection in 6 cases, 4 cases of abdominal pain, air in 3 cases. CT was confirmed in 5 cases (5/9), cystoscopy in 3 cases (3/6), cystography in 2 cases (2/5) and barium enema in 1 case (1/5). Surgical treatment of 10 cases, including lesions of intestinal resection of anastomosis plus partial resection of the bladder in 4 cases, lesions of intestinal resection of anastomosis plus fistula repair or simple bladder drainage in 1 case, a transverse transverse colostomy, two Colon cancer and partial excision of bladder in 1 case, 3 cases of palliative proximal colostomy. Conservative treatment in 2 cases. Results One patient died of septic shock on the 10th day after admission. Nine cases were followed up for 3 months to 16 years, an average of 6.5 years. One case of intestinal fistula recurred and was cured after another operation. One case of conservative treatment and one case of palliative operation died of tumor metastasis, and one case died of cerebrovascular accident 2 years after the operation. Previously, there was no recurrence of intestinal fistula; more than 5 cases Surgical treatment of patients with good, no significant postoperative complications. Conclusions Bladder fistula is mostly secondary to intestinal malignant tumor. The main clinical manifestations are excrement urine and recurrent urinary tract infection. CT and cystoscopy are the preferred methods of examination. The treatment is mainly based on surgery.