吴俊勇+王炜+李彤+罗玲+邓亮

【摘要】 目的：探讨改良经阴道途径手术治疗膀胱阴道瘘的应用效果。方法：2010年7月-2014年5月，对9例膀胱阴道瘘患者实施经尿道用电切镜将膀胱瘘口瘢痕组织电切除，然后改张腿俯卧位用两把小S拉钩及一把阴道重垂拉钩拉开阴道，可清晰显示瘘口。用4-0薇荞线间断缝合瘘口，阴道壁用2-0单荞线连续缝合，观察手术时间、切除瘘口时间、缝合瘘口的时间、出血量、住院时间、并发症发生率，总结手术技巧，并与前期14例经阴道途径（截石位）切除瘘口并缝合进行比较。结果：两组手术均获成功。改良手术组与对照组平均手术时间分别为（49.4±16.2）min、（62±17.1）min，瘘口切除时间（15.2±3.3）min、（29.5±7.4）min，缝合时间（20.5±4.1）min、（32.9±6.1）min，出血量（10.0±2.4）mL、（90.0±20.2）mL，比较差异有统计学意义（P<0.05）。两组尿管放置时间、住院时间和并发症发生率比较，差异无统计学意义。改良手术组随访3～24个月，平均6个月，改良未见漏吸、尿失禁、肾积水及并发症；对照手术组一例出现轻度尿失禁，经盆底训练后好转。结论：经尿道电切除瘘口瘢痕组织出血少及用食指顶起瘘口易于切除，张腿俯卧位显露阴道瘘口明显优于截石位显露阴道瘘口、降低缝合难度、缩短手术时间。

【关键词】 经阴道途径； 膀胱阴道瘘； 电切； 张腿俯卧位

Application Effect of Modified Treatment of Vesicovaginal Fistula Via Transvaginal Route/WU Jun-yong， WANG Wei， LI Tong， et al.//Medical Innovation of China，2014，11（31）：001-003

【Abstract】 Objective： To discuss the application effect of modified surgical treatment of vesicovaginal fistula via transvaginal route. Method： From July 2010 to May 2014， the scar tissues of the bladder fistula from 9 patients with vesicovaginal fistula were resected via transvaginal route by resectoscope. Then， the vagina was pulled open by using two S-shaped retractors and one vaginal retractor to explicitly show the orificium fistulae. The orificium fistulae were intermittently sutured by 4-0 vicryl sutures and the vaginal wall was subject to continuous suture by 2-0 vicryl sutures. The operation time， time of orificium fistulae resection， time of orificium fistulae suture， hemorrhage volume， length of hospital stay and incidence of complications were observed. The surgical skills were summarized and then compared with the previous 14 cases undergoing excision and suture of orificium fistulae via transvaginal route. Result： The surgery was successfully performed in both groups. In the modified surgery group， the mean operation time was （49.4±16.2） min， significantly shorter than （62.0±17.1） min in the control group. The time of orificium fistulae excision was （15.2±3.3） min， significantly shorter compared with （29.5±7.4） min， and time of orificium fistulae suture was （20.5±4.1） min， dramatically shorter than （32.9±6.1） min， and the hemorrhage volume was （10.0±2.4） mL， significantly less than （90.0±20.2） mL in the control group （P<0.05）. The time of ureteral placement， length of hospital stay and incidence of complications did not significantly differ between two groups. In the modified surgical group， the follow-up ranged from 3 to 24 months， 6 months on average. No leakage suction， urinary incontinence， hydronephrosis or alternative complications were observed. In the control group， one case presented with mild urinary incontinence and was improved by pelvic floor muscle training. Conclusion： The scar tissues of the bladder fistula resect via transvaginal route by resectoscope， which yield little hemorrhage. The orificium fistulae could be lifted by the forefinger， which is easy to resect. Compared with the lithotomy position， patients in prone position with leg open could better expose the vaginal orificium fistulae， reduce the difficulty of suturing and shorten the operation time.

【Key words】 Transvaginal route； Vesicovaginal fistula； Electroexcision； Prone position with leg open

First-authors address：Ganzhou Municipal Hospital，Ganzhou 341000，China

doi：10.3969/j.issn.1674-4985.2014.31.001

膀胱阴道瘘是常见的泌尿外科疾病，大部分见于妇科损伤或产科手术及外科手术损伤、放射性损伤以及盆腔恶性肿瘤[1]，患者的临床表现为尿液的持续逸出。尿瘘的发生可出现在损伤时，或损伤后数天或数周内。尿瘘的严重程度取决于瘘道的大小和位置。目前主要治疗方法为手术治疗，国内大部分采用经阴道途径。文献及手术学报道多采用截石位，经阴道显露瘘口比较困难，对于瘘口深者难于显露，瘘口位于上方缝合比较困难。本院于2010年7月-2014年5月采用经尿道电切除瘘口瘢痕组织，然后张腿俯卧位显露阴道瘘口，治疗9例患者，同时用单荞线缝合阴道，效果满意，现总结报告如下。

1 资料……