后正中线切开修补前列腺术后直肠尿道瘘一例报告

前列腺手术后发生直肠尿道瘘临床罕见 ,处理困难。我们采用后正中线切开尾骨和直肠肛管后壁入路成功修补 1例 ,现报告如下。患者 ,5 9岁。因良性前列腺增生行耻骨上经膀胱前列腺摘除术 ,术中直肠损伤并予修补。术后第 9天出现直肠尿道瘘 ,即行乙状结肠腹壁造口 ,并拔除导尿管和保持膀胱造瘘管引流通畅 ,4个月后行瘘修补。尿道镜和经膀胱造瘘口膀胱镜检查见瘘口位于膀胱颈后唇和后尿道 ,瘘口最大径约 2 .5cm ,窥镜经瘘口可顺利进入直肠。直肠指检时食指可通过瘘道扪及膀胱内造瘘管。术前 3d更换膀胱造瘘管 ,每天用碘伏溶液冲洗膀胱和直肠1次 …     

膀胱阴道瘘并发输尿管阴道瘘诊治研究(附11例报告)

目的:探讨膀胱阴道瘘并发输尿管阴道瘘的临床特点及诊治方法.方法:回顾性分析我院11例膀胱阴道瘘并发输尿管阴道瘘患者的临床资料.结果:11例患者均获得正确诊断及手术治疗,随访6个月～5年,尿瘘无复发,输尿管无狭窄.结论:对女性尿瘘患者,应重视膀胱阴道瘘并发输尿管阴道瘘的诊断,选择恰当的手术方式,治疗效果良好.     

肠道膀胱内瘘12例临床分析

目的探讨肠道膀胱内瘘的诊断和处理方法。方法回顾性分析2012年1月至2021年12月期间苏州大学附属第一医院诊断肠道膀胱内瘘12例患者的临床资料。结果 12例患者中直肠膀胱瘘5例, 乙状结肠膀胱瘘4例, 盲肠膀胱瘘1例, 回肠膀胱瘘2例, 其中1例女性患者并存阴道膀胱瘘。行CT检查6例, 肠镜检查5例, 膀胱镜检查6例, 膀胱X线造影检查3例, 肠道X线造影检查2例。11例接受手术治疗, 5例为2次以上手术。1例术后死亡, 2例行肠造口术后好转。1例行病变肠管切除术、膀胱修补术, 3例行病变肠管切除联合部分或全膀胱切除术, 4例行病变肠管切除、膀胱修补、横结肠或回肠造口术。全组12例患者中, 1例术后死亡, 1例未愈, 10例痊愈, 随访至今无复发。结论肠道膀胱内瘘多继发于肠道肿瘤, 临床表现大多为粪尿、尿路感染, CT、膀胱镜、膀胱X线造影或肠道X线造影检查为重要诊断手段, 手术治疗效果良好。     

用气囊导管治疗胃瘘十二指肠瘘2例报告

胃和十二指肠瘘是普通外科的严重并发症 ,其治疗困难 ,病死率较高。作者采用气囊导尿管治疗胃和十二指肠瘘各 1例 ,效果良好 ,报告如下。1　病例报告例 1　男 ,70岁。因“腹膜后神经纤维瘤”行十二指肠第 4段和第 3段部分切除 ,空肠十二指肠第 2段Roux en Y吻合 ,十二指肠第 3段内放置蕈状引流管 ,缝闭残端 ,残端外再放置 1根腹腔引流管 ;术后第 9天残端旁引流管内流出大量消化液 ,每天约 80 0～ 10 0 0ml。同时十二指肠内引流管每天也流出约 12 0 0～ 15 0 0ml消化液 ,诊断为十二指肠残端瘘。将十二指肠内引流管开放引流 ,十二指肠残端旁…     

放射性直肠-阴道瘘和直肠-膀胱瘘的外科治疗

尽管放射治疗的设备和技术有了很大的进步，盆腔放疗后仍约有5％的患者发生直肠和乙状结肠放射性损伤。直肠一阴道瘘和直肠一膀胱瘘是最令人沮丧的并发症之一。对患者是一种巨大的痛苦，对外科医生则是相当艰难的挑战。因为解剖和病理因素，此类放疗并发症大多发生于女性患者。由于子宫和阴道将膀胱隔离，故直肠一阴道瘘的发生率高于直肠一膀胱瘘；如果放疗前子宫已被切除，则大肠与膀胱就有可能相互接触而形成瘘。由于直肠一阴道或膀胱瘘周围组织受到放射性损伤且多存有感染，肠瘘自愈的可能性极小。直接手术修补此类肠瘘通常难以成功，且可能促使瘘口进一步扩大。     

经膀胱造瘘口引出双侧输尿管单J管处理宫颈癌放疗后膀胱阴道瘘的疗效分析

本文回顾性分析我院2015年1月至2021年10月收治的8例宫颈癌放疗后出现膀胱阴道瘘患者的临床资料, 均行局麻下膀胱造瘘, 膀胱镜下留置双侧输尿管单J管, 单J管经膀胱造瘘口引入造瘘袋内。术前患者均长期穿纸尿裤, 生活质量评分(QOL)为(5.3±0.5)分;术后使用尿垫, 0～2块/日, QOL为(2.5±0.5)分, 患者身体异味基本消失。对于各种原因不能手术或手术反复失败的膀胱阴道瘘, 采用经膀胱造瘘口引出双侧输尿管单J管治疗, 可通过较小的创伤, 提高患者的生存质量。     

胃大部切除术后十二指肠残端瘘的防治体会

目的探讨胃大部分切除术(BillrothⅡ式)后十二指肠残端瘘的防治体会。方法确诊后行十二指肠残端瘘口及瘘口附近置管引流,营养支持等,对临床资料进行回顾性分析。结果共收治胃大部切除术后十二指肠残端瘘11例,治疗后所有患者均达到临床治愈,无死亡病例。结论及时诊断、合理治疗是降低术后十二指肠残端瘘的发生率和提高治疗成功率的关键。对十二指肠残端关闭不良患者采取主动造瘘术可有效预防十二指肠残端瘘发生。     

罕见的膀胱臀部瘘1例报告及文献复习

目的：报告1例罕见女性膀胱臀部瘘和复习相关文献,探讨膀胱臀部瘘发病原因、形成机制及治疗原则。方法：患者18年前开始出现右臀部软组织反复感染后臀部漏尿,当地医院先后多次手术治疗无效。后转来我院行膀胱臀部瘘瘘管切除＋膀胱壁无张力修补术,膀胱臀部瘘消失,3个月后复查膀胱镜、尿道造影及尿流率检查。绪果：患者术后3个月复查膀胱镜见膀胱修补处黏膜连续完整、光滑红润,未见瘘口样改变,尿道排泄造影示膀胱充盈好,未见造影剂外渗,尿流率检查示最大尿流率35ml／s,膀胱容量305ml,随访至今尿瘘无复发。结论：膀胱臀部瘘非常罕见的,病因多较复杂,采用瘘管、周围瘢痕切除和膀胱壁分层无张力修补可取得了满意的治疗效果。     

应用膀胱壁瓣治疗复杂膀胱阴道瘘六例报告

复杂膀胱阴道瘘的治疗,一直是妇科和泌尿外科医师焦虑的问题。其原因是瘘孔大,周围疤痕组织多,没有足够的健康组织可以利用,以致创缘对合及缝合均有困难。如瘘口涉及膀胱颈,括约肌受到严重损伤,还需具备有效的控制排尿能力。近年来,我们根据膀胱部分切除和膀胱壁瓣重建尿道的经验,应用转移膀胱壁瓣修补巨大膀胱阴道瘘5例,4例成功,1例失败;应用膀胱壁瓣尿道成形同时阴道成形治疗多发膀胱尿道阴道瘘合并阴遭闭锁1例,获得了非常满意的效果。现介绍如下。一、资料与方法     

十二指肠残端瘘的非手术治疗

目的 探讨十二指肠残端瘘的非手术治疗方法及效果.方法 回顾性分析潍坊医学院附属平度市人民医院2006年1月至2019年12月收治的21例十二指肠残端瘘患者的临床资料,包括治疗过程及结果.结果 21例患者均采用保持腹腔引流通畅,及时行十二指肠腔内减压,抗感染、加强营养为主的非手术疗法,20例痊愈,1例因合并腹腔、尿路及肺...     

Rectal flap advancement – a simple and effective approach for the treatment of rectourethral fistula

Objective Rectourethral fistula is a rare complication of prostatic surgery and other pelvic procedures. We report our experience of surgical repair of using a rectal advancement flap. Patients Three patients with rectourethral fistula following prostatic surgery were treated. Two patients had an anterior partial thickness of rectal flap advancement via a trans‐anal approach without urinary or faecal diversion. In one patient a rectal flap repair was performed through a posterior transsphincteric approach following urinary and faecal diversion. Results No significant postoperative complications occured. Healing was successful in each patient and faecal and urinary continence was normal. Conclusion Transanal rectal advancement flap is a simple and effective technique for the treatment of a rectourethral fistula with no need for urinary or faecal diversion.     

Laparoscopic repair of vesicovaginal fistula

Introduction In developed countries, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with abdominal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Abdominal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair to minimize the surgical morbidity of the transabdominal approach. Methods A 44-year-old female presented with vesicovaginal fistula after abdominal hysterectomy. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed intially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the Trendelenburg position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. Results The operation was uncomplicated. Total operative time was 260 min. Normal diet was resumed on day 1 and patient was discharged on the same day with an indwelling catheter. A cystogram performed 3 weeks post surgery showed resolution of the fistula. Conclusions Laparoscopic repair of vesicovaginal fistula without opening the bladder and using intracorporeal suturing and omentum interpositioning is feasible in selected patients.     

Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition

The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180 degrees to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.     

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。     

Staging rectourinary fistulas to guide surgical treatment

PURPOSE: Surgical management for rectourinary fistulas remains a reconstructive challenge. There are few guidelines to direct the surgeon to the most successful and least morbid technique. We developed a rectourinary fistula staging system that allows selection of the most appropriate technique for the patient. We present the details of the staging system and surgical outcomes. MATERIALS AND METHODS: From July 1999 to July 2005 we treated 14 male patients with rectourinary fistula. Mean patient age was 68 years (range 62 to 73). Etiology was rectal injury during open radical prostatectomy in 5 patients, laparoscopic prostatectomy in 1, radiation induced fistula for prostate cancer treatment (brachytherapy and external beam radiation therapy) in 2, neoadjuvant external beam radiation therapy in 2, ischial decubitus ulcer in 3 with spinal cord injury, and cryotherapy and external beam radiation therapy in 1. Cases were staged as stage I--low (less than 4 cm from anal verge and nonirradiated), stage II--high (more than 4 cm from anal verge and nonirradiated), stage III--small (less than 2 cm irradiated fistula), stage IV--large (more than 2 cm irradiated fistula) and stage V--large (ischial decubitus fistula). Diverting colostomy was performed for stages III to V 6 weeks before definitive therapy. RESULTS: Patients were discharged home after 48 hours. A 22Fr urethral catheter maintained bladder drainage for 3 weeks until cystogram confirmed rectourinary fistula closure. Complications were superficial wound infection and postoperative reexploration of the gracilis flap due to bleeding in 1 case each. All patients were cured after a single operation. CONCLUSIONS: The surgical challenges of a variety of rectourinary fistula repairs can be managed with minimal morbidity and a high success rate using proper staging to guide urinary tract reconstruction.     

Immediate postoperative complications of combined penetrating rectal and bladder injuries

BACKGROUND: Combined penetrating trauma involving the rectum and bladder has been associated with increased postoperative morbidity. Specific complications resulting from these injuries include colovesical fistula, urinoma, and abscess formation. METHODS: A retrospective review of Temple University Hospital trauma database was performed. Patients were categorized by having an isolated rectal (n = 29), isolated bladder (n = 16), or combined injury (n = 24). Records were reviewed for sex, age, site of injury, location of rectal and bladder injuries, operative intervention, fistula formation, urinoma formation, abscess formation, time to urinary catheter removal, length of intensive care unit stay, and length of hospital stay. RESULTS: Patient sex and age did not differ significantly between groups, nor was there a significant difference in location of rectal injury between groups. Presacral drainage was utilized in all patients with extraperitoneal injuries. Fecal diversion was performed in all patients, except two with intraperitoneal rectal injuries. Omental flap interposition between rectal and bladder injuries was utilized in one patient. No significant difference was noted in immediate postoperative complications between groups including fistula, urinoma, and abscess formation. However, all cases of colovesical fistula (n = 2) and urinoma (n = 2) formation were noted in those patients with rectal and posterior bladder injuries. CONCLUSIONS: Combined rectal and bladder injuries were not associated with an increase in immediate postoperative complications compared with isolated rectal and bladder injuries. However, postoperative fistula and urinoma formation occurred only in patients with a combined rectal and posterior bladder injury. Consequently, these patients may benefit from omental flap interposition between injuries to decrease fistula and urinoma formation.     

Long-term results of surgically treated traumatic rectourethral fistulas

OBJECTIVE: Rectourethral fistulas are uncommon, usually iatrogenic injuries that are demanding to treat. We present the challenging problems involving the treatment of rectourethral fistulas caused by war wounds. MATERIALS AND METHODS: In the period 1991-1996, during the war in Croatia and Bosnia, six patients with rectourethral fistulas caused by war injuries were operated in our institution by the same surgeon. All patients were young males with a mean age of 24.6 years. In all patients, double diversion (diversion colostomy and cystostomy) was performed at the time of the injury in military hospitals. In three patients, multiple unsuccessful operations were performed in other institutions to close rectourethral fistula. We found urethrocystography and proctoscopy as the most reliable diagnostic studies and performed them in all patients. In first three patients, we performed transanal repair with anterior rectal wall advancement flap. Because it failed in all three patients, we performed York-Mason trans-sphincteric approach and anterior rectal wall advancement flap after which rectourethral fistula closed in all patients. Because of the satisfactory results, we performed the same procedure in other three patients. RESULTS: In all patients rectourethral fistula healed 2 months after the operation. Closure of diverting colostomy was performed after urethrocystography and proctoscopy proved that the rectourethral fistula has healed. There were no operative deaths and no major complications. Urethral stenosis developed in one patient and was successfully managed by dilatation. CONCLUSION: We believe that York-Mason trans-sphincteric approach offers straightforward access through healthy tissues and good fistula visualization. Anterior rectal wall advancement flap can easily be performed and offer good chances for definitive closure of the rectourethral fistula.     

Acute renal failure caused by complete bladder eversion through a vesicovaginal fistula

We report a rare case of bladder eversion through a vesicovaginal fistula. The bladder prolapse was almost complete, resulting in ureteral kinking, bilateral hydronephrosis and acute renal failure. After reduction of the bladder eversion, bilateral ureteral stent placement, fistula repair using the Latzko technique and colpocleisis, the patient had rapid resolution of her renal compromise.Abbreviations VVF Vesicovaginal fistula     

Laparoscopic repair of vesicovaginal fistula

PURPOSE: Vesicovaginal fistula may be a complication of urogynecologic surgery. We describe the technique of laparoscopic repair of vesicovaginal fistula as performed at our 2 institutions. MATERIALS AND METHODS: Since August 1998 laparoscopic repair of vesicovaginal fistula was performed in 15 select patients who had clear indications to undergo surgical treatment through an abdominal approach. Hysterectomy had previously been performed in 14 patients (93%). Conservative treatment was initially attempted for more than 2 months in all cases. Four patients had undergone a previous surgical fistula closure attempt with unsuccessful results. Our technique involved cystoscopy, catheterization of the vesicovaginal fistula, laparoscopic cystotomy, opening and excision of the fistulous tract, dissection of the bladder from the vagina, cystotomy closure and colpotomy with interposition of a flap of healthy tissue. Demographic as well as perioperative and outcome data were recorded. RESULTS: Average patient age was 38 years. None of the cases required open conversion. Mean operative time was 170 minutes (range 140 to 240). Mean hospital stay was 3 days (range 2 to 5). The mean duration of bladder catheterization was 10.4 days (range 9 to 15) At a mean followup of 26.2 months (range 3 to 60) 14 patients (93%) were cured. CONCLUSIONS: We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity.