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目的:总结女性尿路生殖道瘘临床诊疗经验,探讨复杂性女性尿路生殖道瘘的治疗方法。方法:本组27例,年龄16~56岁,平均41.2岁。其中膀胱阴道瘘9例,输尿管阴道瘘15例,输尿管子宫瘘1例,尿道阴道瘘2例。妇科盆腔手术所致23例,会阴部或盆腔外伤所致3例,放疗所致1例。9例膀胱阴道瘘中,3例行耻骨上经膀胱修补,2例经阴道修补,3例复杂性瘘经腹修补并移植带蒂大网膜,1例放疗后复杂性瘘行输尿管皮肤造口术。15例输尿管阴道瘘中,6例行输尿管镜下输尿管双J管留置术,9例行输尿管膀胱再植术。1例输尿管子宫瘘行耻骨上辅助经脐单孔腹腔镜(SA-LESS)输尿管膀胱再植术。2例尿道阴道瘘均经阴道行修补术,其中1例采用改进三层错位缝合术修补。结果:24例一次治愈,成功率为88.89%(24/27);3例二次手术治愈。平均手术时间75(45~135)min,平均术中出血量60(15~150)ml。术后随访4个月~13年,27例患者均未再出现漏尿,无尿失禁、尿道及阴道狭窄,无继发性肾功能损害。结论:女性尿路生殖道瘘修补手术方法因人因病而定。术前充分准备,选择恰当的手术修补时机、正确的手术修补途径、术中精细操作是提高尿路生殖道瘘手术成功的关键。对复杂性尿瘘,可采用改进三层错位缝合术、辅助带蒂瓣片或网膜技术修补瘘口,促进愈合。
Objective: To summarize the experience of clinical diagnosis and treatment of female urinary tract genital fistula, and to explore the treatment of complex female urinary and reproductive tract fistula. Methods: The group of 27 patients, aged 16 to 56 years, mean 41.2 years old. Including vesico-vaginal fistula in 9 cases, ureteroscopic fistula in 15 cases, ureteral fistula in 1 case, urethral fistula in 2 cases. 23 cases caused by gynecological pelvic surgery, 3 cases caused by perineal or pelvic trauma, and 1 case caused by radiotherapy. In 9 cases of vesicovaginal fistulas, 3 cases underwent suprapubic bladder repair, 2 cases underwent vaginal repair, 3 cases complicated traumatic fistula transabdominal repair and transplanted pedicled omentum, 1 case complicated radiofrequency ablation after ureteral skin stoma Surgery. In 15 cases of ureteric fistula, ureteroscopic ureteral double J tube indwelling was performed in 6 cases and ureteric bladder was replanted in 9 cases. One case of uterine fistula with suprapubic assistant ureteral single hole laparoscopic (SA-LESS) ureter bladder replantation. Two cases of urethral vaginal fistula were vaginal line repair, including one case of improved three-layer dislocation suture repair. Results: 24 cases were cured at one time, the success rate was 88.89% (24/27); 3 cases were cured by the second operation. The average operation time was 75 (45 ~ 135) min, with an average intraoperative blood loss of 60 (15 ~ 150) ml. The patients were followed up for 4 months to 13 years. No leakage of urine, no urinary incontinence, urethral and vaginal stenosis, and no secondary renal impairment occurred in 27 patients. Conclusion: The method of repairing female urinary tract genital fistula depends on human factors. Preoperative preparation, select the appropriate timing of surgical repair, the correct surgical repair, fine operation is to improve the surgical success of urinary tract reproductive tract fistula key. For complex urinary fistula, improved three-tier dislocation suture can be used to assist pedicled flap or omentum repair fistula, and promote healing.