良性子宫切除术时意外膀胱切开术后发生膀胱阴道瘘的危险因素。

Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy.

作者信息

Duong Thinh H, Gellasch Tara L, Adam Rony A

机构信息

Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.

出版信息

Am J Obstet Gynecol. 2009 Nov;201(5):512.e1-4. doi: 10.1016/j.ajog.2009.06.046. Epub 2009 Aug 15.

DOI:10.1016/j.ajog.2009.06.046

PMID:19683697

Abstract

OBJECTIVE

We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies.

STUDY DESIGN

All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data.

RESULTS

A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss.

CONCLUSION

Patients with an AAST grade V cystotomy are at increased risk for VVF formation.

摘要

目的

我们试图评估良性子宫切除术中意外膀胱切开术后膀胱阴道瘘（VVF）的危险因素。

研究设计

回顾了2000年1月至2004年5月期间所有的良性子宫切除术。提取了人口统计学和手术数据。膀胱切开术采用美国创伤外科学会（AAST）系统进行分级。将膀胱切开术后发生VVF的患者与未发生VVF的患者进行比较。分类变量采用Fisher精确检验分析，连续数据采用Student t检验。

结果

共回顾了1317例良性子宫切除术（46%为腹部手术，48%为阴道手术，6%为腹腔镜辅助阴道手术）。总共发生了34例膀胱切开术，其中4例（11.7%）发生了VVF。发生VVF的患者更有可能进行AAST V级膀胱切开术（75%对7%；P = .004）。发生VVF的患者有吸烟更多、子宫更大和手术失血量更多的趋势。