Mileski W J, Joehl R J, Rege R V, Nahrwold D L
Am J Surg. 1987 Jan;153(1):75-9. doi: 10.1016/0002-9610(87)90204-2.
Thirty-four patients with colovesical fistulas seen over a recent 10 year period were reviewed. Diverticulitis was the most common cause of colovesical fistula, accounting for 71 percent of patients in our series. The majority of patients present electively, and most have urinary tract complaints. In those patients in our study who presented with systemic infection, urinary obstruction was present in 70 percent. Although proctosigmoidoscopy and barium enema examination are essential in the preoperative assessment, cystoscopy is the most useful test in suggesting or confirming the diagnosis of colovesical fistula. Intravenous urography is not necessary in the evaluation of these patients. The surgical treatment depends on the cause of the fistula. For patients with an inflammatory cause of the fistula, one-stage operative treatment is associated with low morbidity and decreased length of stay compared with operative treatment in more than one stage. In the presence of severe inflammation or inadequate bowel preparation, two-stage operative treatment is safe and effective. Operations in three stages for colovesical fistula are not indicated. The primary objectives in the management of colovesical fistulas due to unresectable malignancy are relief of intestinal and urinary obstruction and fecal diversion. Resection of the malignancy should be performed whenever possible.
回顾了最近10年期间诊治的34例结肠膀胱瘘患者。憩室炎是结肠膀胱瘘最常见的病因，占本系列患者的71%。大多数患者为择期就诊，且多数有泌尿系统症状。在我们研究的出现全身感染的患者中，70%存在尿路梗阻。虽然直肠乙状结肠镜检查和钡剂灌肠检查在术前评估中必不可少，但膀胱镜检查是提示或确诊结肠膀胱瘘最有用的检查。静脉肾盂造影在这些患者的评估中并非必需。手术治疗取决于瘘的病因。对于瘘由炎症引起的患者，与多期手术治疗相比，一期手术治疗的发病率低且住院时间缩短。在存在严重炎症或肠道准备不充分的情况下，二期手术治疗安全有效。结肠膀胱瘘不建议进行三期手术。因不可切除的恶性肿瘤导致的结肠膀胱瘘的主要治疗目标是解除肠道和尿路梗阻以及粪便转流。只要有可能，就应切除恶性肿瘤。
