Ouedraogo Itengre, Payne Christopher, Nardos Rahel, Adelman Avril J, Wall L Lewis
The Danja Fistula Center, Danja, Niger.
The Worldwide Fistula Fund, Chicago, IL, USA.
Int Urogynecol J. 2018 Mar;29(3):345-351. doi: 10.1007/s00192-017-3375-7. Epub 2017 Jun 9.
The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure.
The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as "easy," "of intermediate complexity," or "difficult" based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression.
The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success ("closed and dry") was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for "easy" cases, 68% for "intermediate" cases, and 57% success for "difficult" cases. Success decreased with increasing numbers of previous attempts at surgical repair.
These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
贫困的西非国家尼日尔产科瘘的发病率很高。我们报告了丹贾瘘管中心384例患者术后6个月的随访情况，并评估了与手术成功或失败相关的因素。
回顾了384名女性在瘘管手术后完成6个月随访的病历。根据术前评分系统，病例分为“简单”“中等复杂”或“困难”三类。使用简单的卡方统计和逻辑回归分析数据。
患者主要为豪萨族（73%），结婚早（平均15.9岁），青少年时期首次怀孕（平均首次分娩年龄16.9岁），产程延长（平均2.3天）且结局不佳（死产率89%）。平均产次为4次。患者通常在首次分娩时发生瘘管（43.5%），但超过一半在随后的分娩中发生瘘管（56.5%）。此前在其他地方进行瘘管手术（平均1.75次手术）的情况很常见。总体手术成功率（“闭合且干爽”）为54%。当单独分析134例初次手术时，总体成功率为80%。手术难度降低，成功率增加：“简单”病例成功率为92%，“中等”病例为68%，“困难”病例为57%。随着先前手术修复尝试次数的增加，成功率降低。
这些数据进一步证明，在专业中心由专家外科医生在训练有素的瘘管护士支持下进行原发性瘘管修复时，临床结局更好。
