Pers M
Scand J Plast Reconstr Surg. 1977;11(2):147-54. doi: 10.3109/02844317709025511.
Reported series of urinary-vaginal fistulas repaired by a vaginal approach show at least 85% primary closure. However, many patients have had several unsuccessful operations elsewhere prior to the final repair. This means that regularly successful closure is possible, but it demands a certain "know-how" and engagement. In search for the general principles leading to such successful primary closure, different published techniques have been studied. It appears that the essential features are the establishment of a proper distance between the inner vesical and the outer vaginal epithelium and the creation of broad raw surfaces to be ajoined. The operation should not involve any risk of enlarging the existing fistula, and the transfer of normal tissue to the site of the repair and the interposition of tissue between the cavities to be separated are sound reconstructive procedures. A personal technique based on these principles is presented. The gynecologists of to-day most often refer urinary-vaginal fistulas to the urologists, who almost without exception prefer a suprapubic transvesical approach. It is strongly recommended that the large majority of urinary-vaginal fistulas should be repaired by the vaginal approach which is a minor intervention. The plastic surgeon should be engaged in the management of urinary-vaginal fistulas.
经阴道途径修复尿阴道瘘的报道系列显示，一期愈合率至少为85%。然而，许多患者在最终修复之前在其他地方经历过几次手术失败。这意味着定期成功闭合是可能的，但需要一定的“诀窍”和投入。为了寻找导致这种成功一期闭合的一般原则，对不同发表的技术进行了研究。似乎基本特征是在膀胱内层和阴道外层上皮之间建立适当的距离，以及形成要对接的宽阔创缘。手术不应有扩大现有瘘管的任何风险，将正常组织转移到修复部位以及在要分隔的腔隙之间插入组织是合理的重建程序。本文介绍了基于这些原则的个人技术。如今的妇科医生大多将尿阴道瘘转诊给泌尿科医生，而泌尿科医生几乎无一例外地更喜欢耻骨上经膀胱途径。强烈建议绝大多数尿阴道瘘应通过阴道途径修复，这是一种小手术。整形外科医生应参与尿阴道瘘的治疗。
