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11.
T. E. Elkins E. Mahama P. O'Donnell D. Fort R. C. Park 《International urogynecology journal》1994,5(3):183-187
Vesicovaginal fistulas (VVFs) occurring as a result of obstetric trauma are a vast problem in Nigeria and Ghana, where at least 20 000 women await repair, and fewer than 50 physicians have the necessary expertise. Through a series of conferences those VVFs that are at high risk and those at low-risk for repair failure, were identified. A clinic was established where repair of low-risk VVFs was done on an ongoing basis in a remote region of Ghana. A visiting surgical team was utilized to repair the difficult, or high-risk, VVFs, which included 4–6 cm VVFs (3), recurrent VVF (1), combined VVF and RVF (rectovaginal fistula), a large 5 cm juxtacervical VVF (1), and a vesicouterine fistula (1). Management of these patients and others with VVF repair complications is discussed. 相似文献
12.
Objective Some conditions, previously managed by general surgeons, may be treated more successfully by colorectal specialists. This argument is well established for rectal cancer but does it also apply to benign conditions? This study compares the treatment strategies and outcomes for fistulae‐in‐ano by general and colorectal surgeons in a district general hospital. Method Patients who had surgery for fistula‐in‐ano from January 1992–October 2003 were identified from theatre records. Case notes were reviewed for data on type of fistula, aetiology, surgery performed and recurrence. All patients were sent a questionnaire requesting details of recurrence and incontinence. The severity of incontinence was assessed using the Faecal Incontinence Quality of Life Scale (FIQOLS) and the Faecal Incontinence Severity Index (FISI). Results Eighty four patients (male = 53) were identified. Colorectal surgeons performed surgery in 34 and general surgeons in 50 patients. These groups were comparable with terms of age, gender, aetiology (colorectal: IBD = 5, cryptoglandular = 21: general IBD = 14, cryptoglandular = 24; P = 0.28; Chi‐squared test), and type of fistulae (colorectal: inter‐sphincteric = 20, trans‐sphincteric = 13: general inter‐sphincteric = 30, trans‐sphincteric = 18: P = 1.0; Fisher's exact test). Colorectal surgeons carried out fewer fistulotomies (47.1%vs 84.0%; P < 0.001; Fisher's exact test), more staged fistulotomies with Setons (44.1%vs 10.0%: P < 0.001; Fisher's exact test), and had fewer recurrences (9.7%vs 30.0%: P < 0.05; Fisher's exact test) when compared with general surgeons. Five patients with recurrence from the general surgery group were subsequently referred to the colorectal surgeons; four patients had further surgery (fistulotomy = 2; staged fistulotomy = 2) with no recurrence to date; one patient required proctectomy. Forty seven (64.4%) patients answered the questionnaire. There was no difference between patients operated on by colorectal or general surgeons with regards the frequency (43.5%vs 62.5%: P = 0.25; Fisher's exact test) or severity [FISI 26 (21–38); median (inter‐quartile range) vs 26 (17–38); median (inter‐quartile range: P = 0.85; Mann–Whitney test) of faecal incontinence. There was no difference between the groups with regards any of the four scales that comprised the FIQOLS. Conclusions The number of included patients is far too low to draw any conclusions but there were some interesting trends. For similar patient samples, colorectal surgeons seem to adopt a more conservative approach and have fewer recurrences than general surgeons. These differences are not reflected in the frequency or severity of postoperative incontinence. 相似文献
13.
目的:探讨PCR检测大鼠外周血及腹水中细菌DNA对空肠-空肠、回肠-回肠吻合口瘘的早期诊断价值。方法:健康Wistar雌性大鼠50只,随机分成5组,每组10只:A组为假手术组;B组为空肠-空肠吻合组;C组为空肠吻合口瘘组;D组为回肠-回肠吻合组;E组为回肠吻合口瘘组。采集手术前后外周血及术后腹水,抽提DNA, 比较lacZ基因和16SrRNA基因的PCR阳性率,并观察各组的病理学情况。结果:(1)C,E组术后外周血lacZ基因PCR阳性率与B,D组无显著性差异(P>0.05);C,E组术后外周血16SrRNA基因PCR阳性率显著高于B,D组(P<0.05)。(2)C,E组腹水lacZ基因和16SrRNA基因PCR阳性率均显著高于B,D组(P<0.05)。(3)C,E组腹水lacZ基因阳性率显著高于外周血(P<0.05);C,E组腹水16SrRNA基因阳性率与外周血无显著性差异(P>0.05)。结论:(1)PCR检测术后外周血16SrRNA基因对空、回肠吻合口瘘的早期诊断有一定意义;(2)检测术后腹水lacZ基因和16SrRNA基因对空肠-空肠、回肠-回肠吻合口瘘的早期诊断也有一定意义。 相似文献
14.
显微外科技术治疗复杂膀胱尿道阴道瘘(附五例报告) 总被引:7,自引:1,他引:6
目的 总结显微外科技术修补复杂性膀胱尿道阴道瘘的经验。方法 膀胱尿道瘘患者4例,膀胱阴道多发瘘1例,均在手术放大镜下用细线行瘘修补,膀胱颈缺损多层缝合或利用阴道壁修补尿道缺损。结果 5例均一次修补成功,随访6~12个月,排尿均通畅。1例膀胱颈全尿道缺损者咳嗽时有轻微尿失禁,余4例无尿失禁、无漏尿,性生活满意。结论 多层缝合膀胱颈缺损可恢复膀胱颈括约肌功能,显微外科技术组织对合好、反应小,有利于尿瘘愈合。 相似文献
15.
S. Elabd G. Ghoniem M. Elsharaby M. Emran A. Elgamasy T. Felfela A. Elshaer 《International urogynecology journal》1997,8(4):185-190
The aim of the study was to evaluate endourological techniques in the management of iatrogenic ureterovaginal fistula. Seventeen
patients referred to us after gynecologic surgery were diagnosed as having iatrogenic ureterovaginal fistula. First, retrograde
double-J stenting was tried. If this failed, percutaneous nephrostomy using an antegrade double-J stent was performed. If
this also failed, open surgical repair was performed. The retrograde double-J stent bypassed the fistula in 2 patients (11.8%).
Percutaneous nephrostomy was performed in the remaining 15. The antegrade double-J stent bypassed the fistula in another 2
of these patients (11.8%). Open surgical repair was performed in the remaining 13 patients (67.5%) (direct ureteroneocystostomy)
with nipple valve in 11 patients and Boari flap with psoas hitch in 2 patients). Of all patients, 2 had ureteral stricture,
one after antegrade double-J stenting and the other after open repair. It was concluded that early intervention is recommended
in the treatment of iatrogenic uretrovaginal fistula, causing minimal morbidity and discomfort, and being less expensive.
EDITORIAL COMMENT: This is an interesting paper that is worthy of mention because of an important concept in the management
of an iatrogenic ureterovaginal fistula. The traditional management of these fistulas has been ureteroneocystostomy [1]. However,
recent urologic literature suggests that modern endoscopic treatment is highly successful if the passage of an internal stent
is possible [2,3]. This is a concept that must be shared with our urogynecologic colleagues.
In this paper, 4 of 14 patients with an iatrogenic fistula underwent placement of an indwelling stent. Of these, two were
placed cystoscopically, whereas the other two were placed percutaneously. All four ureterovaginal fistulas healed successfully.
However, 1 patient developed a ureteral stricture. It is noteworthy that in the combined series of Selzman [2] and this Tulane
group not only were all ureterovaginal fistulas successfully treated with a stent, but only 1 of 11 patients (9%) developed
a stricture.
Although the sample size is small, this paper supports the conclusion that successful endoscopic placement of a double-J stent
does allow the ureterovaginal fistula to heal spontaneously. Therefore, initial endoscopic management of an iatrogenic ureterovaginal
fistula is a reasonable recommendation. However, equally important is the development of a ureteral stricture causing ‘silent
hydronephrosis’. After stent removal the patient may develop a distal ureteral stricture with a completely asymptomatic hydronephrosis
— ‘silent hydronephrosis’. Although the patient may be clinically asymptomatic, the renal units remain in jeopardy. Therefore,
routine periodic follow-up with radiologic studies is warranted after stent removal. 相似文献
16.
Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons 总被引:1,自引:0,他引:1
Three pediatric patients underwent successful transcatheter coronary artery fistula occlusion using the Debrun system. This
latex balloon system offers several advantages over other occlusion systems. First, the balloon delivery and release is controlled.
Second, “test occlusions” can be performed that allow simultaneous balloon inflation, coronary cineangiography, and electrocardiographic
monitoring. Third, because the balloons are flow-directed, they are easily positioned in properly chosen locations. Finally,
the balloons can be constructed to suit the size of the fistula. In this study, two patients received only one balloon; in
the other patient two balloons were placed in the same fistula. All fistulas drained into either the right atrium or ventricle
and were successfully occluded. After a follow-up period of up to 3 years, no local or systemic reactions to the balloons
were recognized. We conclude that detachable balloon occlusion of coronary artery fistulas is a safe, effective alternative
to surgical ligation in selected pediatric patients. 相似文献
17.
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19.
First branchial cleft fistula is a rare congenital malformation of the head and neck with an incidence of less than 10% of all branchial cleft defects. We herein report a 15-year-old girl who had a cystic mass in the postauricular region with an external opening on the posterior face of the earlobe. Surgical exploration revealed that a second sinus tract was passing through the conchal cartilage without going beyond the skin of the external acoustic meatus. The mass and the tract were excised along with the opening on the earlobe as well as the skin island surrounding the opening. The case was treated surgically with success .The significance of our case was the location of external opening on the earlobe. 相似文献
20.
本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离.以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口,以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗,即肠内营养,阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗,大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。 相似文献