经腹腹腔镜治疗妇科术后膀胱阴道瘘的初步体会

目的总结经腹途径腹腔镜在膀胱阴道瘘修补中的可行性及疗效。方法2012年12月至2017年12月暨南大学附属第一医院因子宫全切除(n=6,均为开放手术)或宫颈癌根治术后(n=1)致膀胱阴道瘘患者共7例,年龄42~57岁,所有瘘口均位于输尿管嵴以上,瘘口直径0.5~3.5 cm,尿瘘病史3个月~5年余,其中2例既往有1~2次经膀胱修补失败病史。采用经腹腹腔镜下膀胱阴道瘘修补术,直视下放置操作通道,其中5例瘘口较大或复发性膀胱阴道瘘采用大网膜填充膀胱与阴道之间的间隙。术后留置尿管2~3周。结果7例患者手术均顺利完成,手术时间150~280 min,出血量50~150 ml,无输血,术后拔除尿管后尿瘘消失。随访6~54个月未出现尿瘘。结论经腹腹腔镜修补高位膀胱阴道瘘微创、有效,尤其是复发性病例,但尚需更多临床资料论证。

Transperitoneal laparoscopy in the treatment of vesicovaginal fistula caused by gynecologic surgery

ObjectiveTo summarize feasibility and efficacy of transperitoneal laparoscopy in the treatment of vesicovaginal fistulas. MethodsBetween December 2012 and December 2017, 7 patients (aged 42-57 years) who had underwent open total hysterectomy (n=6) or radical resection of cervical cancer (n=1) caused vesicovaginal fistulas. The fistulas were located above the ureteral fistula, the fistula diameter was 0.5-3.5 cm, and the duration of urinary fistula was between 3 months and 5 years. Among them, 2 cases had a history of bladder repair failure 1-2 times. Laparoscopic repair of vesicovaginal fistulas was performed. Trocar was placed under direct vision. Five of them had large or recurrent vesicovaginal fistulas using an omentum to fill the gap between bladder and the vagina. Indwelling catheter for 2-3 weeks. ResultsAll operation were performed successfully, the operation time was 150-280 minutes and the blood loss was 50-150 ml. No blood transfusion was required. After the catheter was removed, the urine fistula disappeared. No urinary fistula occurred during 6-54 months of follow-up. ConclusionLaparoscopic repair of high vesico-vaginal fistula is minimally invasive and effective, especially in recurrent cases, but more clinical data are needed to demonstrate.