与宫颈环扎术相关的泌尿生殖瘘的共性。

Commonalities of cerclage-related genitourinary fistulas.

作者信息

Massengill Jason C, Baker Tieneka M, Von Pechmann Walter S, Horbach Nicolette S, Hurtado Eric A

机构信息

Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA.

出版信息

Female Pelvic Med Reconstr Surg. 2012 Nov-Dec;18(6):362-5. doi: 10.1097/SPV.0b013e318270aa7c.

DOI:10.1097/SPV.0b013e318270aa7c

PMID:23143432

Abstract

OBJECTIVES

The purpose of this review was to identify common features of cerclage-related genitourinary fistulas.

METHODS

A retrospective case series of cerclage-related fistulas was performed. The results were then pooled with available published case reports to identify common factors in these cases. Fistula location, surgical technique, and previous surgical and obstetrical histories were examined.

RESULTS

From 2008 to 2011, 5 women were referred with vesicovaginal fistulas after cerclage. Within this series, 4 had prior cervical procedures, 3 had previous cesarean deliveries, and 4 had a McDonald cerclage in the antecedent pregnancy. When pooled with available data in 7 published case reports on cerclage-related fistulas, all 12 fistulas occurred in patients with prior histories of cervical procedures or cesarean deliveries. Specifically, of the 12 patients, 8 [66.7%; 95% confidence interval (CI), 0.39-0.86] had at least 1 prior cerclage and 10 (83.3%; 95% CI, 0.54-0.97) had at least 1 prior cervical surgery. When reported, 81.8% (95% CI, 0.51-0.96) had the McDonald technique used for placement of the current cerclage.

CONCLUSIONS

The isolated and pooled findings suggest previous cerclage, any previous cervical procedures, and use of the McDonald technique are common factors in cases of cerclage-related genitourinary fistulas. This information may be useful when evaluating and counseling patients.

摘要

目的

本综述的目的是确定与宫颈环扎术相关的泌尿生殖瘘的共同特征。

方法

对与宫颈环扎术相关的瘘管进行回顾性病例系列研究。然后将结果与现有的已发表病例报告汇总，以确定这些病例中的共同因素。检查瘘管位置、手术技术以及既往手术和产科病史。

结果

2008年至2011年，有5名女性在宫颈环扎术后出现膀胱阴道瘘。在该系列中，4名患者既往有宫颈手术史，3名有既往剖宫产史，4名在前次妊娠时行麦克唐纳宫颈环扎术。当与7篇关于宫颈环扎术相关瘘管的已发表病例报告中的现有数据汇总时，所有12例瘘管均发生在有宫颈手术史或剖宫产史的患者中。具体而言，在这12例患者中，8例（66.7%；95%置信区间[CI]，0.39 - 0.86）至少有1次既往宫颈环扎术，10例（83.3%；95%CI，0.54 - 0.97）至少有1次既往宫颈手术。报告显示，81.8%（95%CI，0.51 - 0.96）在放置当前宫颈环扎术时采用了麦克唐纳技术。