Chu Lei, Wang Jian-Jun, Li Li, Tong Xiao-Wen, Fan Bo-Zhen, Guo Yi, Li Huai-Fang
Department of Obstetrics and Gynecology, Tongji Hospital of Tongji University Shanghai 200065, China.
Int J Clin Exp Med. 2015 Feb 15;8(2):2364-70. eCollection 2015.
To investigate the clinical efficacy of laparoscopic repair of iatrogenic vesicovaginal fistulas (VVF) and rectovaginal fistulas.
Seventeen female patients with iatrogenic fistulas (11 cases of VVF and 6 cases of high rectovaginal fistulas) were included. All patients were hospitalized and underwent laparoscopic fistula repair in our hospital between 2008 and 2012. The mean age of the patients was 44.8 ± 9.1 years. The fistulas and scar tissue were completely excised by laparoscopy, orifices were tension-free closed using absorbable sutures, omental flaps were interposed between the vagina and the bladder or rectum, and drainage was kept after repair.
Laparoscopic repair of fistulas was successful in all 17 patients. No complication was found during or after repair. No reoperation was needed after the repair. The operative time was 80.2 ± 30.0 minutes (range 50-140 minutes). The blood loss was 229.4 ± 101.6 ml (range 100-400 ml). The double J catheters were placed in 7 patients and removed 1-2 months after repair. Eight VVF patients underwent cystoscopy 3 months after laparoscopic repair and there were no abnormal findings. The follow-up time was 17.1 ± 6.5 months (range 8-29 months).
Laparoscopic repair of VVF and rectovaginal fistulas is a safe and an effective minimally invasive procedure for treatment of iatrogenic fistula.
探讨腹腔镜修复医源性膀胱阴道瘘（VVF）和直肠阴道瘘的临床疗效。
纳入17例医源性瘘管的女性患者（11例VVF和6例高位直肠阴道瘘）。2008年至2012年期间，所有患者均在我院住院并接受腹腔镜瘘管修复术。患者的平均年龄为44.8±9.1岁。通过腹腔镜将瘘管和瘢痕组织完全切除，使用可吸收缝线无张力闭合瘘口，在阴道与膀胱或直肠之间置入网膜瓣，并在修复后进行引流。
17例患者腹腔镜修复瘘管均成功。修复过程中及修复后均未发现并发症。修复后无需再次手术。手术时间为80.2±30.0分钟（范围50 - 140分钟）。失血量为229.4±101.6毫升（范围100 - 400毫升）。7例患者放置了双J导管，修复后1 - 2个月取出。8例VVF患者在腹腔镜修复后3个月接受膀胱镜检查，未发现异常。随访时间为17.1±6.5个月（范围8 - 29个月）。
腹腔镜修复VVF和直肠阴道瘘是治疗医源性瘘管的一种安全有效的微创手术。
