Mondet F, Chartier-Kastler E J, Conort P, Bitker M O, Chatelain C, Richard F
Department of Urology, Pitié-Salpétrière Hospital, University Pierre et Marie Curie (Paris VI), Paris, France.
Urology. 2001 Dec;58(6):882-6. doi: 10.1016/s0090-4295(01)01395-4.
To evaluate the anatomic and functional results of transperitoneal-transvesical repair of simple and complex vesicovaginal fistulas (VVFs).
Between 1978 and 1995, 30 VVFs in 28 patients (mean age 44.6 years, range 21 to 80) were treated by way of a transperitoneal-transvesical approach. VVFs were secondary to hysterectomy in 67.8% of cases; 46.7% of VVFs were considered complex fistulas. Fifty percent of the VVFs were retrotrigonal and 40% were trigonal. A flap was interposed in 70% of cases. The vaginal fistula orifice was left open in 66% of cases, and 33% of VVFs required ureteral reimplantation. The mean duration of bladder drainage was 15.8 days (range 6 to 42), and the mean follow-up was 30 months (range 23 days to 14.6 years). The anatomic and functional results were evaluated by physical examination, cystoscopy, and a self-assessment questionnaire. Success was defined as the disappearance of the fistula.
The overall success rate was 85% (24 of 28). The success rate was 87.5% for simple VVFs, 71% for complex VVFs, 93% for retrotrigonal VVFs, 66% for cervicotrigonal VVFs, and 80% for fistulas requiring ureteral reimplantation. Postoperative voiding disorders were reported in 38% of patients.
Transperitoneal-transvesical repair of simple and complex VVFs remains the reference treatment for a disease that has become rare in countries with a well-developed healthcare system, but that is disabling and poorly tolerated by patients after the treatment of another disease.
评估经腹-经膀胱修复单纯性和复杂性膀胱阴道瘘（VVF）的解剖学及功能学结果。
1978年至1995年间，采用经腹-经膀胱入路治疗了28例患者的30例膀胱阴道瘘（平均年龄44.6岁，范围21至80岁）。67.8%的病例中膀胱阴道瘘继发于子宫切除术；46.7%的膀胱阴道瘘被认为是复杂性瘘。50%的膀胱阴道瘘位于膀胱三角后，40%位于膀胱三角区。70%的病例中置入了皮瓣。66%的病例中阴道瘘口保持开放，33%的膀胱阴道瘘需要输尿管再植术。膀胱引流的平均持续时间为15.8天（范围6至42天），平均随访时间为30个月（范围23天至14.6年）。通过体格检查、膀胱镜检查和自我评估问卷对解剖学及功能学结果进行评估。成功定义为瘘消失。
总体成功率为85%（28例中的24例）。单纯性膀胱阴道瘘的成功率为87.5%，复杂性膀胱阴道瘘为71%，膀胱三角后瘘为93%，宫颈膀胱三角区瘘为66%，需要输尿管再植术的瘘为80%。38%的患者报告有术后排尿障碍。
对于在医疗保健系统发达的国家已变得罕见，但在另一种疾病治疗后会导致患者残疾且耐受性差的疾病，经腹-经膀胱修复单纯性和复杂性膀胱阴道瘘仍是参考治疗方法。
