Department of Obstetrics and Gynecology, Mennonite Christian Hospital, Hualien, Taiwan.
Taiwan J Obstet Gynecol. 2012 Sep;51(3):359-62. doi: 10.1016/j.tjog.2012.07.007.
In developed countries, vesicovaginal fistula (VVF) is a rare complication after gynecological surgery. In this report, the Latzko procedure was used to repair VVF to evaluate its safety and efficacy.
Between 1991 and 2009, cases in which VVF developed after various gynecological surgeries and repaired using the Latzko procedure were included. The cause of VVF and outcome after Latzko procedure were reported. The previous published reports regarding Latzko procedure were also listed and compared. The median follow-up period was 8 years.
Six cases of VVF were documented in this period. All fistulas were simple type with a fistular size of less than 2cm. In three of six cases, fistulas developed after a hysterectomy for carcinoma in situ of cervix. Of those remaining, one case developed after staging an operation for endometrial adenocarcinoma, while the other two cases occurred after hysterectomy for myoma. Five cases were repaired successfully. One case had postoperative complications such as fever and urinary tract infection. Intraoperative blood loss and hospital stay were minimal. There was no recurrence of VVF postoperatively among successful cases during the follow-up period.
Adequate exposure of the fistular site is a key point to a successful repair. The Latzko method is a minimal access procedure for VVF repair. This technique may be considered a first-line treatment of VV fistula.
在发达国家，妇科手术后发生膀胱阴道瘘（VVF）是一种罕见的并发症。在本报告中，我们使用 Latzko 手术修复 VVF，以评估其安全性和疗效。
1991 年至 2009 年间，我们收治了 6 例因各种妇科手术后发生 VVF 而接受 Latzko 手术修复的患者。报告了 VVF 的病因和 Latzko 手术后的结果。同时还列出并比较了之前发表的关于 Latzko 手术的报告。中位随访时间为 8 年。
在此期间，我们共发现 6 例 VVF。所有瘘管均为单纯型，瘘管大小小于 2cm。在 6 例患者中，有 3 例因宫颈癌前病变行子宫切除术而发生瘘管，另外 3 例中有 1 例因子宫内膜腺癌分期手术，2 例因子宫肌瘤行子宫切除术。5 例患者成功修复。1 例患者术后出现发热和尿路感染等并发症。术中出血量和住院时间均较少。在随访期间，成功修复的病例均未出现 VVF 复发。
充分暴露瘘管部位是手术成功的关键。Latzko 法是一种微创修复 VVF 的方法。该技术可作为 VVF 的一线治疗方法。
