一项关于良性子宫切除术中意外膀胱切开术后膀胱阴道瘘的多中心研究。
A multicenter study of vesicovaginal fistula following incidental cystotomy during benign hysterectomies.
作者信息
Duong Thinh H, Taylor David P, Meeks G Rodney
机构信息
Department of Gynecology and Obstetrics, Section of Urogynecology and Pelvic Reconstructive Surgery, Emory University School of Medicine, Glenn Memorial Building, 69 Jesse Hill Jr. Dr., SE, Atlanta, GA 30303, USA.
出版信息
Int Urogynecol J. 2011 Aug;22(8):975-9. doi: 10.1007/s00192-011-1375-6. Epub 2011 Feb 19.
INTRODUCTION AND HYPOTHESIS
To evaluate factors for vesicovaginal fistula (VVF) formation following incidental cystotomies during benign hysterectomies.
METHODS
Hysterectomies performed at two university centers between January 1, 2000 and December 31, 2008 were reviewed. Demographic and operative data were abstracted. Patients who developed VVF were compared to those with no VVF.
RESULTS
During the study period, 5,698 hysterectomies performed for benign indications were identified. One hundred two (1.8%) cystotomies occurred with 6 (5.9%) developing a VVF. Patients with VVF were more likely to have uteri weighing > 250 g (83% vs. 36%, P = 0.03), had longer surgeries (317 ± 82 vs. 208 ± 10 min, P = 0.02) and more ureteral injuries (33% vs. 1%, P = 0.009). American Association for the Surgery of Trauma (AAST) grade V bladder injuries (OR, 93.00; 95% CI, 10.30-838.92) were associated with VVF formation.
CONCLUSIONS
Patients with AAST grade V bladder injuries are at increased risk for developing vesicovaginal fistulas following incidental cystotomies during benign hysterectomies.
引言与假设
评估良性子宫切除术中意外膀胱切开术后膀胱阴道瘘（VVF）形成的相关因素。
方法
回顾2000年1月1日至2008年12月31日在两个大学中心进行的子宫切除术。提取人口统计学和手术数据。将发生VVF的患者与未发生VVF的患者进行比较。
结果
在研究期间，共确定了5698例因良性指征进行的子宫切除术。发生了102例（1.8%）膀胱切开术，其中6例（5.9%）发生了VVF。发生VVF的患者子宫重量>250g的可能性更高（83%对36%，P=0.03），手术时间更长（317±82对208±10分钟，P=0.02），输尿管损伤更多（33%对1%，P=0.009）。美国创伤外科协会（AAST）V级膀胱损伤（比值比，93.00；95%可信区间，10.30 - 838.92）与VVF形成相关。
结论
在良性子宫切除术中意外膀胱切开术后，AAST V级膀胱损伤患者发生膀胱阴道瘘的风险增加。
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