子宫切除术后输尿管阴道瘘

子宫切除术后输尿管阴道瘘（山东省立医院妇产科）１病例摘要患者４７岁，４０天前因子宫肌瘤在某区医院行金子宫切除术。术后第１天出现腹痛、腹胀，进行性加重，腹部逐渐增大如７～８个月妊娠，尿量少。术后３天行腹腔穿刺抽出淡黄色液体，怀疑肝硬化腹水。术后７天拆线...     

输尿管膀胱再植术治疗输尿管膀胱阴道瘘1例

患者 44岁。因阴道漏尿 13年,于 2004年 1月 30日入院。19岁结婚,孕 6产 4,剖宫产 2次,平产 2次。13年前末次妊娠在家分娩失败, 2d后在县医院剖宫产 1死婴,产后即出现阴道漏尿,未予治疗。5年前在当地县医院行膀胱切开取石并修补瘘孔,无效。绝经 2年。体查:下腹正中 13cm长手术瘢痕,宽度 3cm,外阴皮炎,阴道前穹窿消失,偏左处见 1 5cm直径凹陷,此处见清亮尿液流出,金属导尿管自尿道外口探入约 4cm,可达瘘孔处。膀胱镜检:膀胱黏膜光滑,膀胱前壁显示手术后改变。膀胱内未见结石及新生物,右侧输尿管口清晰,喷尿清,左侧输尿管开口未见,相当于…     

双J管治疗输尿管阴道瘘的临床应用

我院应用双Ｊ管治疗输尿管阴道瘘 2 4例取得满意疗效 ,现报道如下。1　资料与方法1 1　一般资料　我院 1995年 1月至 2 0 0 1年 6月共收治输尿管阴道瘘 2 4例 ,年龄 2 2～ 6 0岁 ,平均 48岁 ,漏尿发生在开腹手术和阴式全子宫切除术后 8～ 2 1天。1 2　诊断标准　临床表现为阴道漏尿伴发热、腰痛、肾区叩击痛 ,Ｂ超、静脉尿路造影 (ＩＶＵ)检查示患侧输尿管上段扩张 ,肾积水 ,膀胱内注入美蓝不见阴道蓝染 ,静脉内注入靛咽脂阴道内蓝染而确诊。1 3　方法1 3 1　置管方法 :患者一经确诊即行膀胱镜下逆行插管 ,将带有导丝的Ｆ3双Ｊ管从患侧输尿…     

妇产科手术后并发输尿管阴道瘘五例报告及文献复习

输尿管阴道瘘多发生于妇产科手术所致的输尿管损伤后，可引起尿瘘、尿外渗、感染和肾功能损害。为提高对这一并发症的认识，降低其发生率，我们总结了我院妇产科1999年至2006年间收治的输尿管阴道瘘患者共5例的临床资料，并结合国内外文献，对其发生的原因、诊断及临床处理作一探讨。     

膀胱阴道瘘47例手术治疗临床分析

目的探讨妇科手术并发膀胱阴道瘘的病因、治疗及预防措施。方法回顾分析中国人民解放军总医院2000年1月至2009年12月间收治的47例妇科手术、放疗后等并发膀胱阴道瘘患者的临床资料,经美兰试验和膀胱镜检查确诊。妇科手术引起膀胱阴道瘘42例,4例行双侧输尿管经皮造瘘术,43例行修补术,其中25例(58.1%)经膀胱修补,18例(41.9%)经阴道修补。结果本文43例修补术患者中,37例1次修补成功,3例2次修补后成功。术后随访1～6个月无复发。结论妇科子宫切除手术所致膀胱阴道瘘为最多见,术前充分准备及术后严格管理大大提高手术成功率。     

膀胱阴道瘘34例病因及处理

目的探讨膀胱阴道瘘的病因及治疗方式。方法回顾性分析1964-2005第三军医大学大坪医院34例膀胱阴道瘘患者的临床表现、治疗措施及效果。结果本资料显示1990年前膀胱阴道瘘患者病因主要为产科因素，占83．3％，而1990年后妇科手术则成为主要病因，占70．0％。手术治疗30例，一次修补成功23例，其中经阴道修补9例，腹膜内经膀胱修补5例，腹膜外经膀胱修补9例，二次修补成功7例，1例均经阴道进行，6例先后经膀胱或阴道修补成功。结论目前妇科手术为膀胱阴道瘘的主要病因，且瘘口相对简单，其治疗措施仍以手术为主；提高产科质量及妇科操作技能是预防本病的关键。     

泌尿生殖道瘘的病因及类型

泌尿生殖道瘘指泌尿系统及生殖系统之间存在的异常通道。分娩、手术损伤、先天发育异常、盆腔炎症疾病及肿瘤是出现泌尿生殖道瘘的重要因素。膀胱阴道瘘、输尿管阴道瘘、尿道阴道瘘、膀胱子宫瘘均是泌尿生殖道瘘的常见类型,该文将概括介绍其发病原因、危险因素及诊断方法等。     

改良经阴道早期膀胱阴道瘘修补术临床疗效分析

目的 探讨妇产科手术致膀胱阴道瘘后早期施行改良经阴道修补术的临床疗效。方法 回顾性分析46例膀胱阴道瘘患者的临床资料,按修补术距漏尿发生的时间分为两组：研究组（n=23）为确诊后即刻行修补术;对照组（n=23）为确诊后等待3～6个月后行修补术。分析两组患者手术成功率、出血量、手术时间、住院时间、复发率、并发症及满意度。结果 两组患者手术成功率（91.3%, 95.6%）、术中出血量[（36.7±7.4） ml,(37.0±6.4) ml]、手术时间[（50.3±7.1） min,(51.4±8.4) min]、住院时间[（16.6±1.8） d,(17.1±2.4) d]比较,差异均无统计学意义（P>0.05）。研究组患者行为限制、心理影响明显优于对照组（P <0.05）。结论 妇产科手术损伤所致的膀胱阴道瘘,早期施行改良经阴道修补手术,疗效满意,无需等待3个月或以上。     

重视膀胱阴道瘘诊治

生殖道与泌尿道之间的任何部位异常通道均构成了尿瘘,尿液自阴道排出,不能控制。尿瘘可发生在生殖道与泌尿道之间的任何部位,除外少数因为恶性肿瘤和结核等疾病所致尿瘘外,更多地与妇科手术与产科操作有关,也是妇产科医生容易面对医疗纠纷的疾病。因临床所遇病例不多,妇产科医生普遍存在尿瘘知识更新不够等问题。在该领域的专业机构为国际尿控学会（ International Continence Society, ICS）下属的瘘委员会（Fistula Committee）和国际产科瘘学会(International Society of Obstetric Fistula Surgeons, ISOFS),对瘘的诊治进行专科培训和知识进展更新。现将在尿瘘诊治方面国际更新的内容分述如下。     

保留瘘管经阴道途径修补膀胱阴道瘘10例临床分析

目的:探讨经阴道保留瘘管修补膀胱阴道瘘的方法和优越性.方法:10例确诊的膀胱阴道瘘患者,病史4个月至18年,全部经阴道途径行膀胱阴道瘘修补术,其中多个瘘口2例,单一瘘口8例,共10例14个瘘口.结果:全部病例均未切除瘘管,一次修补成功9例,二次修补成功1例,手术时间平均50±8.3分钟,术中出血10～30 ml,术后平均住院天数3.5天,随访3个月到半年无复发.结论:经阴道途径修补膀胱阴道瘘不仅具有创伤小、手术时间短的优点,而且手术成功率高,保留瘘管不切除并不导致手术失败率增加,但可减少手术时间及降低手术难度.     

Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis

Objective  Iatrogenic ureteral injury during gynaecological surgery is associated with increased morbidity when not diagnosed during the initial surgery. Preoperative insertion of ureteral catheters may enhance intraoperative recognition of injury and repair, but it is controversial. We sought to analyse the costs of this approach.
Design/setting/population  A decision-tree analysis of clinical scenarios of using universal ureteral catheterisation compared with no catheterisation was conducted for benign abdominal hysterectomy and radical hysterectomy.
Methods  Diagnostic-Related Groups and Current Procedural Terminology coding and reimbursement information were used as calculated for Medicare patients in the USA.
Main outcome measures  Differences in projections of total hospital-related costs related to clinical scenarios of perioperative care for women undergoing hysterectomy with or without ureteral catheterisation.
Results  Universal ureteral catheterisation is cost saving when the rate of ureteral injury during benign abdominal hysterectomy or radical hysterectomy is greater than 3.2%.
Conclusions  The cost savings of universal ureteral catheterisation at hysterectomy depend on the injury rate but are minimal at common levels of injury.     

剖宫产手术子宫瘘的诊治

剖宫产手术子宫瘘主要发生于发展中国家,随着社会经济的发展,其在我国的发病率逐渐降低,但是近年来凶险性前置胎盘的发病率升高,术中损伤增加。因此,剖宫产后的子宫瘘仍需引起大家的重视。文章对剖宫产手术最常见的子宫瘘进行阐述,以期为其诊治提供参考和依据。     

医源性尿瘘预防与新的尿瘘治疗方法

分娩损伤及妇科手术损伤是医源性尿瘘的主要病因,针对病因的预防措施是降低医源性尿瘘的根本所在。随着现代医学的进步和科学技术的日新月异,机器人辅助内镜手术将成为未来治疗的趋势。     

Eliminating obstetric fistula: progress in partnerships.

Obstetric fistula persists in the developing world due to poor access to obstetric care. It has been overlooked in the past, as the women suffering from fistula often live on the fringe of society due to their poverty and the stigma surrounding the condition. A global Campaign to End Fistula is bringing a variety of actors together to raise awareness and support to prevent fistula and provide comprehensive treatment for women living with fistula. This paper describes the strategies and progress of the campaign since it began in 2003.     

Obstetric fistula: the challenge to human rights.

Obstetric fistula can be explained to result from different causes. These holes in the tissue wall between the vagina and bladder and/or rectum are most prevalent in resource-poor countries, attributable to prolonged obstructed labour and absent or inaccessible remedial prenatal services. Obstructed labour is often due to small pelvic size, resulting from women's youth and premature childbearing and/or malnutrition. Poverty at national health-service and family levels often predisposes pregnant populations to suffer high rates of fistula. Global estimates showing up to 100,000 new cases each year and 2 million affected girls and women are probably gross underestimates. Fistula devastates lives of sufferers, who are often expelled by husbands and become isolated from their families and communities. Failures of states to provide prenatal preventive care (including medically indicated cesarean deliveries) and timely fistula repair violate women's internationally recognized human rights, especially to healthcare in general and reproductive healthcare in particular.     

先天性泌尿生殖道畸形合并泌尿生殖道瘘

先天性泌尿生殖道畸形合并泌尿生殖道瘘是一类少见的、复杂的先天性畸形,易误诊误治,需要对其有全面的认识和评估,并制定正确的治疗方案。     

Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy

AIM: Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS: Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS: The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS: UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure.