膀胱肠瘘诊断治疗12例报告

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。

Diagnosis and treatment of enterovesical fistula (report of 12 cases)

Objective To assess the diagnosis and treatment of enterovesical fistula.Methods The clinical data of 12 cases (10 men and 2 women;mean age,57 years) of enterovesical fistula were retro- spectively analyzed.Of the 12 cases,7 (58%) had colovesical fistula,3 (25%) had ileovesical fistula,and 2 (17%) had rectovesical fistula.The etiology of fistula was intestinal malignancy in 7 cases,Crohn disease in 3 ,and bladder cancer in 1,and intestinal diverticulitis in 1.The clinical features included fecaluria in 10 cases,recurrent urinary tract infection (UTI) in 6,abdominal pain in 4,and pneumaturia in 3.Five patients (5/9) had a definite diagnosis by CT;3 (3/6),by cystoseopy;2 (2/5),by cystography;and 1 (1/5),by barium enema.Among the 10 patients undergoing surgical intervention,resection of the involved bowl with one-stage anastomosis and partial cystectomy was performed in 4;resection of the bowl with one-stage anasto- mosis and repair of the fistula or single bladder drainage in each of 2;one-stage transverse colostomy and two- stage radical colectomy with partial cystectomy in 1;palliative proximal colostomy in 3;and conservative ther- apy in 2.Results One patient died of septic shock 10 d after admission.Nine patients were followed for 3 months to 16 years (mean,6.5 years).One patient had intestinal fistula recurrence and was cured with re- operation;1 patient with conservative therapy and 1 with palliative surgery died of tumor metastasis;and 1 died of cerebrovascular accident 2 years later without fistula recurrence previously.Five patients undergoing surgery had a better survival with no complication.Conclusions The major cause of enterovesical fistula is intestinal malignancy.Fecaluria and recurrent UTI are the most common symptoms.CT and cystoscopy are the preferred adjunctive examinations.Surgical intervention is the major therapeutic choice.