McFadden Erin, Taleski Sarah Jane, Bocking Alan, Spitzer Rachel F, Mabeya Hillary
Faculty of Medicine, University of Toronto, Toronto, ON.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2011 Jan;33(1):30-35. doi: 10.1016/S1701-2163(16)34769-7.
We examined success rates and complications of obstetric fistula (OF) surgical repairs in association with patient and fistula characteristics, including sociocultural and socioeconomic determinants of health. A better understanding of these associations will help guide surgical management and prevent predisposing factors.
We reviewed the medical records of 86 patients who underwent OF repair at Moi Teaching and Referral Hospital in Kenya between 1999 and 2007.
Women with OF presented for repair with a variety of concurrent conditions. Seventy-eight percent had laboured for at least 24 hours; 29% had undergone previous unsuccessful surgery. Of the women who presented at postoperative follow-up, 54% still complained of incontinence. Persistent incontinence was associated with larger, more complicated fistulas and having had previous failed attempts at surgical repair.
The association of factors such as duration of labour with OF reflects the limited availability of obstetrical care in Western Kenya. There is a significant difference in postoperative success of fistula repair between women with large fistulas or those who had previous failed surgery and other patients. This reflects the importance of primary and secondary prevention.
我们研究了产科瘘管（OF）手术修复的成功率和并发症，并将其与患者及瘘管特征相关联，包括健康的社会文化和社会经济决定因素。更好地理解这些关联将有助于指导手术管理并预防诱发因素。
我们回顾了1999年至2007年间在肯尼亚莫伊教学与转诊医院接受OF修复手术的86例患者的病历。
患有OF的女性在修复时伴有多种并发情况。78%的患者分娩时间至少达24小时；29%的患者此前曾接受过不成功的手术。在术后随访的女性中，54%仍抱怨存在尿失禁问题。持续性尿失禁与更大、更复杂的瘘管以及此前手术修复失败有关。
分娩时间等因素与OF的关联反映出肯尼亚西部产科护理服务有限。瘘管较大或此前手术失败的女性与其他患者相比，瘘管修复术后的成功率存在显著差异。这反映了一级和二级预防的重要性。
