摘要
目的:探讨腹腔镜膀胱肌瓣输尿管成形术治疗输尿管阴道瘘的疗效。方法:回顾性分析2018年7月至2023年1月广西医科大学第四附属医院诊治的13例输尿管阴道瘘患者的临床资料。患者年龄36～66岁，平均年龄（51±8）岁，发现阴道不自主漏尿时间为妇科手术后（2～20）d，平均（11±5）天。所有患者均采用腹腔镜膀胱肌瓣输尿管成形术治疗，分析患者的手术时间、住院时间、术中出血量和术后临床疗效。结果:本组13例患者均成功完成腹腔镜膀胱肌瓣输尿管成形术，手术时间（85～180）min，平均（109±23）min，住院时间（8～15）d，平均（10±2）d，术中出血量（20～300）ml。术前血肌酐（65±15）μmol/L，术后患者肌酐（53±9）μmol/L，两者差异有统计学意义（P<0.05）。13例患者术后均无阴道漏尿，其中2例患者拔除双J管后1月复查CT提示出现轻度和中度肾积水，但患者血肌酐值均在正常范围（术前分别为52 μmol/L和70 μmol/L，术后分别为48 μmol/L和60 μmol/L）。轻度肾积水患者随访至拔管后3个月其肾积水未继续加重，中度肾积水患者随访至拔管后3个月复查CT提示肾积水减轻。1例患者术后出现反复尿路感染。所有患者术后均无伤口脂肪液化。所有患者均获得随访，随访时间3～9个月。结论:腹腔镜膀胱肌瓣输尿管成形术治疗输尿管阴道瘘具有创伤小、恢复快、疗效确切和并发症少等优点，是一种可靠有效的手术方式。
Abstract
Objective:To explore the effectiveness of laparoscopic bladder muscle flap ureteroplasty for the treatment of ureterovaginal fistula.Methods:A retrospective analysis was conducted on the clinical data of 13 patients with ureterovaginal fistula treated in the Fourth Affiliated Hospital of Guangxi Medical University from July 2018 to January 2023. The patients' ages ranged from 36 to 66 years, with an average of (51±8) years, The time of involuntary vaginal leakage was found to be 2-20 days after gynecological surgery, with an average time of (11±5) days. All patients underwent laparoscopic bladder muscle flap ureteroplasty. The operation time, length of hospital stay, intraoperative blood loss and postoperative clinical outcomes of the 13 patients were analyzed.Results:All 13 patients in this group successfully underwent laparoscopic bladder muscle flap ureteroplasty. The operation time ranged from 85 to 180 min, with an average of (109±23) min. The hospital stay ranged from 8 to 15 days, with an average of (10±2) days. The intraoperative blood loss ranged from 20 to 300 ml. The preoperative creatinine was (65±15) μmol/L, and the postoperative creatinine was (53±9) μmol/L, with a statistically significant difference (P<0.05). After the surgery, all 13 patients did not have any vaginal leakage of urine. Among them, two patients showed mild to moderate renal hydronephrosis on CT examination one month after removing the double-J stent, but the creatinine indexes were within the normal range (preoperative 52 μmol/L and 70 μmol/L, and postoperative 48 μmol/L and 60 μmol/L, respectively). The patient had mild hydronephrosis that did not continue to worsen until 3 months after removal of the double-J stent, the hydronephrosis of the other patient as reduced by follow-up CT examination until 3 months after removal of the stent. One patient had recurrent urinary tract infection after surgery. All patients had no wound fat liquefaction after the surgery. All patients were followed up for 3 to 9 months.Conclusion:Laparoscopic bladder muscle flap ureteroplasty for the treatment of ureterovaginal fistula is a reliable and effective surgical procedure. It provides the advantages of less trauma, fast recovery, precise efficacy, and fewer complications.
基金项目
广西壮族自治区卫生健康委员会自筹经费课题(Z20190243)
万方数据