de Moya Marc A, Zacharias Nikolaos, Osbourne Audley, Butt Muhammad Umar, Alam Hasan B, King David R, McGovern Francis, Velmahos George C
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Surg Res. 2009 Oct;156(2):274-7. doi: 10.1016/j.jss.2009.03.094. Epub 2009 May 8.
Colovesical fistula (CVF) are the most common occurring fistulae secondary to diverticulitis. Review of the literature reveals great variability in postoperative Foley catheter management, as well as the role of a cystogram. The purpose of this study was to review our experience in early vs. late removal of the Foley catheter after CVF repair secondary to diverticulitis. Our hypothesis was that early Foley catheter removal is not associated with increased complications, and postoperative cystogram is of low value.
This is a retrospective study (January 2002-March 2008) of all patients with a diagnosis of CVF secondary to diverticulitis, who were treated with a sigmoidectomy and takedown of the fistula. Hospital records were reviewed and demographics, days to Foley removal, performance of cystogram, type of repair, complications, and comorbidities were recorded. Patients were separated into two groups according to early or late Foley catheter removal. Removal of the Foley catheter in < or = 7 d was considered early, and removal in >7 d was considered late.
Thirty-two patients were identified, with a mean age of 65.2 y (42-91). Mean duration of Foley catheter stay was 15.6 d (3-42). Six patients had early postoperative Foley catheter removal and 26 patients had late Foley catheter removal. Four patients had complex bladder repair, and they all had late Foley catheter removal. From the 28 patients with simple bladder repair, six had early removal and 22 had late removal. Patients with early Foley catheter removal did not have significant complications compared with patients with late Foley catheter removal. Eleven patients got a cystogram postoperatively to detect possible bladder leaks. All cystograms performed were negative.
Patients with a diagnosis of CVF secondary to diverticulitis may have their Foley catheter removed in 7 d without any increased complications. The role of the cystogram is unclear; however, no value was added in simple bladder repairs.
结肠膀胱瘘（CVF）是憩室炎继发的最常见的瘘管。文献回顾显示，术后导尿管管理以及膀胱造影的作用存在很大差异。本研究的目的是回顾我们在憩室炎继发CVF修复术后早期与晚期拔除导尿管的经验。我们的假设是早期拔除导尿管与并发症增加无关，且术后膀胱造影价值不大。
这是一项回顾性研究（2002年1月至2008年3月），纳入所有诊断为憩室炎继发CVF且接受乙状结肠切除术和瘘管切除的患者。查阅医院记录，记录人口统计学资料、拔除导尿管的天数、膀胱造影的实施情况、修复类型、并发症和合并症。根据导尿管拔除的早晚将患者分为两组。在≤7天拔除导尿管被视为早期，在＞7天拔除被视为晚期。
共确定32例患者，平均年龄65.2岁（42 - 91岁）。导尿管留置的平均时间为15.6天（3 - 42天）。6例患者术后早期拔除导尿管，26例患者晚期拔除导尿管。4例患者进行了复杂的膀胱修复，他们均为晚期拔除导尿管。在28例进行简单膀胱修复的患者中，6例早期拔除，22例晚期拔除。与晚期拔除导尿管的患者相比，早期拔除导尿管的患者没有明显并发症。11例患者术后进行膀胱造影以检测可能的膀胱渗漏。所有进行的膀胱造影结果均为阴性。
诊断为憩室炎继发CVF的患者可在7天内拔除导尿管，且不会增加并发症。膀胱造影的作用尚不清楚；然而，在简单膀胱修复中并无价值。
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