Langkilde N C, Pless T K, Lundbeck F, Nerstrøm B
Department of Urology, Aarhus University Hospital, Skejby Sygehus, Denmark.
Scand J Urol Nephrol. 1999 Apr;33(2):100-3. doi: 10.1080/003655999750016069.
Vesicovaginal fistulae in the western world generally occur as complications to pelvic surgery or radiation therapy of pelvic cancers. We have reviewed our results of vesicovaginal fistula closure procedures over a 10-year period.
From 1985 to 1996, 55 patients were referred to our department due to vesicovaginal fistulae. Five patients had fistulae due to malignant recurrence and one patient was considered inoperable. Thus, 49 patients were operated on. Thirty patients had fistulae resulting from pelvic surgery. Nineteen of the 25 patients admitted with fistulae secondary to radiation therapy of pelvic cancers were operated on.
Of the 30 patients with postoperative fistulae, 23 had an abdominal repair and 7 a vaginal repair. A success rate of 90% was achieved after a first closure procedure, as 3 patients within a month experienced a recurrence. These three recurrences were all successfully closed in a second operation, augmenting the success rate to 100% in this group of patients. In the group of patients with fistulae caused by irradiation, a urinary diversion was performed in 12 patients, and in 7 patients a primary attempt to close the fistula was made, either by an abdominal approach (2 patients) or by a vaginal approach (5 patients). The fistula recurred in 6 of these 7 patients. Despite several additional attempts to close the recurrent fistulae, only one patient was successfully operated on.
It seems that vesicovaginal fistulae resulting from pelvic surgery, in our hands, can be managed successfully either by an abdominal or vaginal approach. For patients with vesicovaginal fistulae resulting from radiation therapy, a urinary diversion appears to be the method of choice.
在西方世界，膀胱阴道瘘通常是盆腔手术或盆腔癌症放射治疗的并发症。我们回顾了10年间膀胱阴道瘘修补手术的结果。
1985年至1996年，55例因膀胱阴道瘘转诊至我科。5例因恶性肿瘤复发导致瘘管形成，1例被认为无法手术。因此，49例患者接受了手术。30例患者的瘘管由盆腔手术引起。25例因盆腔癌症放射治疗继发瘘管而入院的患者中，19例接受了手术。
30例术后瘘管患者中，23例行腹部修补术，7例行阴道修补术。首次修补术后成功率为90%，因为有3例患者在一个月内复发。这3例复发病例均在第二次手术中成功闭合，使该组患者的成功率提高到100%。在因放疗导致瘘管的患者组中，12例患者进行了尿流改道，7例患者首次尝试闭合瘘管，其中2例采用腹部入路，5例采用阴道入路。这7例患者中有6例瘘管复发。尽管多次尝试闭合复发性瘘管，但只有1例患者手术成功。
在我们手中，盆腔手术导致的膀胱阴道瘘似乎可以通过腹部或阴道入路成功处理。对于放疗导致的膀胱阴道瘘患者，尿流改道似乎是首选方法。
