妇科手术后或放疗后瘘管

Tidsskr Nor Laegeforen. 2020 Sep 7;140(12). doi: 10.4045/tidsskr.19.0822. Print 2020 Sep 8.

BACKGROUND

Gynaecological fistulae cause urinary and/or faecal incontinence. Haukeland University Hospital has systematically recorded treatments for gynaecological fistulae, since 2012 in its capacity as the Norwegian National Unit for Gynaecological Fistulae. This study describes characteristics of and therapeutic outcomes for gynaecological fistulae caused by surgery and/or radiotherapy.

MATERIAL AND METHOD

We have conducted a retrospective cohort study of women who were treated at the Department of Gynaecology and Obstetrics, Haukeland University Hospital, in the period 1995-2019 for gynaecological fistulae due to surgery or radiotherapy.

RESULTS

Surgery or radiotherapy was the cause of gynaecological fistulae in 182 of a total of 411 women. 163 of them consented to the study, 124/163 (76 %) with fistulae following surgery and 39/163 (24 %) with fistulae following radiotherapy. The post-surgical fistulae were mainly urogenital (91/124: 73 %) and most often caused by a hysterectomy (n = 71) or urinary incontinence procedure (n = 11). Post-radiotherapy fistulae were mainly enterogenital (34/39: 87 %), with rectal cancer (n = 22) and cervical cancer (n = 11) as the most frequent types of cancer. The main procedure was vaginal fistuloplasty, which was carried out on 100/124 (81 %) of women with post-surgical fistula and 7/39 (18 %) of those with post-radiotherapy fistula. Catheter drainage or stomy alone resulted in healing in 14/163 (9 %) of all patients. A total of 117/124 (94 %) of women with post-surgical fistula achieved healing, compared with 10/39 (26 %) with post-radiotherapy fistula. 28/39 (72 %) of the latter had a permanent urostomy or enterostomy.

INTERPETATION

Gynaecological fistulae caused by surgery have a good healing rate, while post-radiotherapy fistulae are more often permanent.

背景

妇科瘘会导致尿失禁和/或粪便失禁。自 2012 年以来，豪克兰大学医院作为挪威妇科瘘国家单位，系统地记录了妇科瘘的治疗情况。本研究描述了手术和/或放疗引起的妇科瘘的特征和治疗结果。

材料和方法

我们对 1995 年至 2019 年在豪克兰大学医院妇科和产科接受治疗的因手术或放疗引起的妇科瘘的妇女进行了回顾性队列研究。

结果

手术或放疗导致 411 名妇女中的 182 名发生妇科瘘。其中 163 名妇女同意参与本研究，124/163（76%）例瘘为手术引起，39/163（24%）例瘘为放疗引起。手术后瘘主要为尿生殖瘘（91/124：73%），最常见的原因是子宫切除术（n=71）或尿失禁手术（n=11）。放疗后瘘主要为肠生殖瘘（34/39：87%），最常见的癌症类型为直肠癌（n=22）和宫颈癌（n=11）。主要手术为阴道瘘修补术，124 例手术后瘘中有 100 例（81%）和 39 例放疗后瘘中有 7 例（18%）进行了该手术。单独引流或造口术使 163 例患者中的 14 例（9%）治愈。手术后瘘的 124 例患者中，有 117 例（94%）治愈，而放疗后瘘的 39 例患者中，只有 10 例（26%）治愈。后者中有 28 例（72%）永久性行尿流改道术或肠造口术。