生殖瘘——我们的经验

Biswas Arati, Bal Runa, Alauddin M, Saha Sudarsan, Kundu Mrinal Kanti, Mondal Parthajit

Department of Obstetrics and Gynaecology, Calcutta National Medical College, Kolkata.

J Indian Med Assoc. 2007 Mar;105(3):123-6.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

生殖道瘘给女性生活带来了巨大的生理和心理社会问题。本研究旨在记录生殖道瘘的种类、病因以及手术矫正的结果。共有42例不同类型的生殖道瘘患者纳入本研究。详细询问了生殖道瘘的病因，特别是膀胱阴道瘘的病因。确诊后进行手术矫正。在生殖道瘘的类型中，膀胱阴道瘘占76.19%，直肠阴道瘘占11.90%，输尿管阴道瘘、尿道阴道瘘和膀胱宫颈瘘分别占4.76%、4.76%和2.38%。初产妇因产科原因是生殖道瘘的主要受害者。关于膀胱阴道瘘的病因，71.87%的患者有产科原因，包括产程延长、器械助产以及因产程梗阻行剖宫产术后。腹部子宫切除术（44.44%）是膀胱阴道瘘妇科病因的首位。输尿管阴道瘘病例多发生在腹部子宫切除术后。1例尿道阴道瘘是由于应用某种化学药物矫正生殖器脱垂所致。直肠阴道瘘大多是由产科原因引起的。膀胱阴道瘘首次修复的成功率为82.75%，总体失败率为10.34%。其他类型的瘘修复成功率为100%。通过警惕的产科护理和细致的手术可以降低生殖道瘘的发生率。