Section for International Health, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2011 Jul;90(7):753-60. doi: 10.1111/j.1600-0412.2011.01162.x. Epub 2011 May 25.
The aim of the study was to investigate obstetric fistula in terms of patient demographics, fistula characteristics and predictors of surgical outcome.
Retrospective cross-sectional study.
Fistula referral hospital in eastern Democratic Republic of Congo. Population. Five hundred and ninety-five women receiving fistula repair from November 2005 to November 2007.
Review of patient records for information on patient demographics, obstetric history, clinical data for index pregnancy, fistula characteristics and surgical information. Cross-tabulations and multivariate logistic regression models were used to predict surgical outcome.
Fistula closure and incontinence despite fistula closure. Results. 82.9% had developed fistula following obstructed labor, 17.1% after medical interventions of which 71.1% involved cesarean section or peripartum hysterectomy. Median age at fistula development was 23 years; 40.8% were primiparous and 43.2% were parity three or more. Women took a median of two years to seek treatment. Closure rate was 87.1%, with 15.6% remaining incontinent. Failure to close the fistula was significantly associated with previous repairs, amount of fibrosis and fistula size. Compared with primary repairs, the odds ratio of failure was almost five times greater for three or more repairs (odds ratio 4.7, 95% confidence interval 2.2-10.0). Incontinence was significantly associated with previous repairs, amount of fibrosis and fistula location. Compared with fistulas with a high location, the odds ratio of incontinence for low, circumferential fistulas was 6.3 (95% confidence interval 2.5-16.4).
Fistula in Democratic Republic of Congo was found in both primiparous and multiparous women, indicating a need for increased access to obstetric care for all pregnant women. Fistulas repaired for the first time, with no fibrosis and size <2 cm, had the best surgical outcome.
本研究旨在探讨产科瘘的患者特征、瘘管特征和手术结果的预测因素。
回顾性横断面研究。
刚果民主共和国东部的瘘管转诊医院。
2005 年 11 月至 2007 年 11 月期间接受瘘管修复的 595 名女性。
查阅患者病历，获取患者人口统计学资料、产科病史、本次妊娠临床数据、瘘管特征和手术信息。使用交叉表和多变量逻辑回归模型预测手术结果。
瘘管闭合和尽管瘘管闭合仍有失禁。
82.9%的患者因梗阻性分娩后发生瘘管，17.1%的患者因医疗干预后发生瘘管，其中 71.1%涉及剖宫产或围产期子宫切除术。瘘管发生的中位年龄为 23 岁；40.8%为初产妇，43.2%为三产或以上。患者中位就诊时间为 2 年。闭合率为 87.1%，15.6%仍有失禁。瘘管未闭合与既往修补、纤维化程度和瘘管大小显著相关。与初次修补相比，三次或以上修补失败的比值比几乎为五倍（比值比 4.7，95%置信区间 2.2-10.0）。与初次修补相比，纤维化程度和瘘管位置与失禁显著相关。与高位瘘管相比，低位、环状瘘管失禁的比值比为 6.3（95%置信区间 2.5-16.4）。
刚果民主共和国的瘘管可见于初产妇和经产妇，表明需要增加所有孕妇的产科保健服务。首次修复、无纤维化且<2cm 的瘘管手术结果最佳。
Zotero 插件