Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Gynaecol Obstet. 2012 Oct;119(1):18-20. doi: 10.1016/j.ijgo.2012.04.026. Epub 2012 Jul 25.
To describe an approach for managing 10 patients with complex, mixed trigonal-supratrigonal vesiõcovaginal fistulas (VVFs) using the rotational bladder flap technique.
The 10 patients were undergoing their second to fourth repair of a mixed trigonal-supratrigonal VVF. The fistula was approached transabdominally, the bladder was opened along the sagittal plane and a bladder flap was rotated downward and medially to fill the fistula defect. First, the vaginal defect was repaired as usual; then, an omental flap was interposed and fixed between the vagina and bladder; finally, the fistula and posterior wall of the bladder were meticulously sutured in 1 layer.
Fistula closure was unsuccessful in 1 patient, in whom the corrugated drain had entered the bladder via the suture line. The fistulas were repaired successfully in the 9 remaining patients, with no recurrence or surgical reintervention for any reason for the follow-up duration.
The rotational bladder flap technique is safe and effective for the repair of complex, mixed trigonal-supratrigonal VVFs which always require tension-free approximation.
描述一种使用旋转膀胱瓣技术治疗 10 例复杂混合三角-上三角型膀胱阴道瘘（VVF）患者的方法。
这 10 例患者均接受了第二次至第四次修复复杂混合三角-上三角型 VVF。经腹入路，沿矢状面切开膀胱，旋转膀胱瓣向下并向内侧填充瘘口缺损。首先，常规修复阴道缺损；然后，将网膜瓣置于阴道和膀胱之间并固定；最后，仔细地将瘘口和膀胱后壁缝合 1 层。
1 例患者因波纹引流管通过缝线进入膀胱而导致瘘口关闭失败。其余 9 例患者的瘘口均成功修复，随访期间无复发或因任何原因再次手术干预。
旋转膀胱瓣技术对于需要无张力吻合的复杂混合三角-上三角型 VVF 的修复是安全有效的。
