应用尿道球海绵体肌瓣修补女性复杂尿瘘的探讨

目的:探讨应用尿道球海绵体肌瓣修补女性复杂尿瘘的可行性。方法:经腹经会阴经阴道途径游离膀胱阴道瘘或尿道阴道瘘瘘口,彻底切除瘘口周围疤痕组织,缝合阴道侧瘘口。在大、小阴唇之间作切口,游离尿道球海绵体肌,保护来自后下方的供应血管,离断尿道球海绵体肌的阴蒂端,经小阴唇隧道将该肌置于膀胱(或尿道)侧瘘口及阴道侧瘘口之间,将尿道球海绵体肌蒂端缝合固定于周围器官。结果:应用尿道球绵体肌瓣转移术修补复杂膀胱阴道瘘7例,复杂尿道阴道瘘1例,同时行阴道疤痕切除置模术1例。所有病例术后未再发生阴道漏尿,无尿失禁和尿道狭窄,性生活正常。结论:尿道球绵体肌瓣转移术设计合理、操作简单、是治疗女性复杂尿瘘的理想术式。

Explore the application of the urethral bulbocavernous muscle flap for repair of female patients with complicated urinary fistulas

Objective:To explore the application of the urethral bulbocavernous muscle flap for repairing female patients with complicated urinary fistulas. Methods: The cystovaginal and ure-therovaginal fistulas were freed through abdomen, perineum and vagina, the scar tissue around fistula was resected thoroughly, the fistulas near vagina were sutured. Urethral bulbocavernous muscle was freed through the incision between labium majus pudendi and labium minus pudendi. The nutrient artery should be protected. The clitoris end of urethal bulbocavernous muscle was excised. Urethral bulbocavernous muscle flap was placed between bladder (urethra) fistula and vagina through labium minus pudendi tunnel. The clitoris end of urithral bulbocavernous muscle was fixed in peripheral organs . Results: 7 complicated cystovaginal fistulas and 1 complicated urthrovaginal fistula were repaired with the colpoplasty. There were no vaginal leakage of urine in all patients after operation. There were also no urinary incontience,urethral stricture and sexual life was normal. Conclusions: Transposition of urethral bulbocavernous muscle flap is devised naturally and manipulated easily. It is a good method of treatment of female patients with complicated fistulas.