Wein A J, Malloy T R, Carpiniello V L, Greenberg S H, Murphy J J
Surg Gynecol Obstet. 1980 Jan;150(1):57-60.
Thirty-four vesicovaginal fistulas of various causes were repaired using a suprapubic, transvesical approach modified after the original technique of O'Connor. Only four failures resulted. Two of the failures were attributed to residual or recurrent carcinoma and two to poor tissue healing resulting from an inadequate delay between the initial surgical procedure and an attempt at reconstructive surgery. Surgical complications included three wound infections and one instance of severe gastrointestinal bleeding. Technical considerations thought to be important include excision of all diseased tissue in the bladder and vagina; complete separation of the bladder from the vagina with a margin of healthy tissue in all directions; careful, watertight closure of both bladder and vagina without tension; interposition of peritoneum or omentum between the closed bladder and vagina, and initial postoperative maintenance of an uninfected and dry suture line.
采用经耻骨上、经膀胱入路，在奥康纳原技术基础上改良，修复了34例各种原因导致的膀胱阴道瘘。仅4例修复失败。其中2例失败归因于残留或复发性癌，2例归因于初次手术与重建手术尝试之间间隔时间不足导致组织愈合不良。手术并发症包括3例伤口感染和1例严重胃肠道出血。认为重要的技术要点包括切除膀胱和阴道内所有病变组织；膀胱与阴道完全分离，四周均有健康组织边缘；膀胱和阴道均仔细、无张力地进行水密缝合；在闭合的膀胱和阴道之间置入腹膜或网膜，术后初期保持缝合线无感染且干燥。
