改良经阴道途径治疗膀胱阴道瘘的应用效果

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。

Application Effect of Modified Treatment of Vesicovaginal Fistula Via Transvaginal Route

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 hemor