Elkins T E, Ghosh T S, Tagoe G A, Stocker R
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Obstet Gynecol. 1992 Mar;79(3):455-60. doi: 10.1097/00006250-199203000-00026.
Repair of vesicovaginal fistulas resulting from obstetric trauma remains a major challenge to surgeons worldwide. Large defects that result in partial or total urethral loss are especially difficult to repair. Even when closure of such fistulas is accomplished, return of normal urogenital function is often impaired, underscoring the need to improve existing surgical procedures. Transvaginal urethral and bladder neck reconstruction using mobilized anterior bladder wall was helpful in closing 18 of 20 vesicovaginal fistulas with urethral involvement caused by obstetric trauma. This method involves advancement of an anterior bladder wall flap into the vagina, where it is rolled into a neo-urethra or connected to whatever remnant of urethral tissue exists. Complications included stress incontinence requiring further surgery (four), small bladder capacity with detrusor instability (two), urethral stenosis requiring dilatation (two), postoperative hemorrhage (one), and vaginal stenosis (one). Continued modification of this procedure holds promise for many patients considered inoperable in the past.
产科创伤导致的膀胱阴道瘘修复仍是全球外科医生面临的重大挑战。导致部分或全部尿道缺失的大缺损尤其难以修复。即使成功闭合此类瘘管，泌尿生殖功能的恢复也常常受损，这突出表明需要改进现有手术方法。使用游离的膀胱前壁进行经阴道尿道和膀胱颈重建有助于闭合20例因产科创伤导致尿道受累的膀胱阴道瘘中的18例。该方法包括将膀胱前壁皮瓣推进阴道，在阴道内将其卷成新尿道或与现存的尿道组织残余相连。并发症包括需要进一步手术的压力性尿失禁（4例）、伴有逼尿肌不稳定的膀胱容量小（2例）、需要扩张的尿道狭窄（2例）、术后出血（1例）和阴道狭窄（1例）。对该手术方法的持续改进有望为许多过去被认为无法手术的患者带来希望。
