Loposso Matthieu, Hakim Lukman, Ndundu Jean, Lufuma Simon, Punga Augustin, De Ridder Dirk
Department of Development and Regeneration, Urology, KU Leuven, Leuven, Belgium; Department of Surgery, Urology Division, University Hospital of Kinshasa, Kinshasa, DR Congo.
Department of Development and Regeneration, Urology, KU Leuven, Leuven, Belgium; Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Urology. 2016 Nov;97:80-85. doi: 10.1016/j.urology.2016.03.079. Epub 2016 Aug 2.
To determine factors contributing to recurrence and successful treatment of obstetric fistula (OF).
Data were collected from OF patients in Saint Luc Hospital Kisantu (DR of Congo) between 2007 and 2013. Patients underwent surgical treatment and were evaluated after a follow-up period of 3 months. Successful treatment was defined as no or dry pads whereas recurrence was defined as the persisting need for wearing incontinence pads immediately after the surgery or after a period of dryness. Fistula classification was done according to Waaldijk. Univariate and multivariate analyses were performed using logistic regression, corrected for preoperative and intraoperative OF characteristics.
Median age of 166 OF patients was 29.11 ± 9. 6 years (range 5-61). The majority of OF was type I (57.2%) followed by type III (20.5 %). There were 20.5% who showed vaginal fibrosis during surgical treatment. The most common location of fistula was pericervical (39.8%). The global recurrence rate at 3 months was 28.3%, with type IIBb (100%) as most the common recurring, followed by IIAb (66.67%) and IIAa (41.18%). There were 71.7%, 15.7%, 12%, and 0.6% patients who were considered completely cured, partially cured (downstaged), persistent, and upstaged, respectively. OF patients with fibrosis were 68% less likely (odds ratio 0.32, 95% confidence interval 0.14-0.73; P = .0065) to be dry in comparison to those without fibrosis. Patients with urethral fistula were 73% less likely (odds ratio 0.27, 95% confidence interval 0.11-0.63; P = .0024) to be dry compared to other locations.
This study showed that fibrosis and urethral location are independent risk factors for fistula recurrence or persistence following surgical fistula repair.
确定导致产科瘘（OF）复发及成功治疗的因素。
收集2007年至2013年期间刚果民主共和国基桑图圣卢克医院OF患者的数据。患者接受手术治疗，并在3个月的随访期后进行评估。成功治疗定义为无垫或垫干燥，而复发定义为术后或干燥一段时间后仍持续需要使用失禁垫。瘘管分类按照瓦尔迪克方法进行。采用逻辑回归进行单因素和多因素分析，并对术前和术中的OF特征进行校正。
166例OF患者的中位年龄为29.11±9.6岁（范围5 - 61岁）。大多数OF为I型（57.2%），其次是III型（20.5%）。手术治疗期间有20.5%的患者出现阴道纤维化。瘘管最常见的位置是宫颈周围（39.8%）。3个月时的总体复发率为28.3%，其中IIBb型（100%）是最常见的复发类型，其次是IIAb型（66.67%）和IIAa型（41.18%）。分别有71.7%、15.7%、12%和0.6%的患者被认为完全治愈、部分治愈（降级）、持续存在和升级。与无纤维化的患者相比，有纤维化的OF患者干燥的可能性低68%（比值比0.32，95%置信区间0.14 - 0.73；P = 0.0065）。与其他位置的患者相比，尿道瘘患者干燥的可能性低73%（比值比0.27，95%置信区间0.11 - 0.63；P = 0.0024）。
本研究表明，纤维化和尿道位置是瘘管手术修复后复发或持续存在的独立危险因素。
