Meeks G R, Sams J O, Field K W, Fulp K S, Margolis M T
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Am J Obstet Gynecol. 1997 Dec;177(6):1298-303; discussion 1303-4. doi: 10.1016/s0002-9378(97)70068-1.
The objective of this study was to determine whether suture placement through the bladder during closure of the vaginal cuff at the time of transabdominal hysterectomy is associated with formation of postoperative vesicovaginal fistula.
Virgin female New Zealand White rabbits were used to perform this study. The study protocol was approved by the institutional Animal Use and Care Committee. Animals were housed and maintained in the animal facilities at the University of Mississippi Medical Center according to appropriate guidelines. Thirty-two animals were randomized into two groups at a 2:1 ratio. All animals underwent transabdominal hysterectomy. Animals in group 1 (n = 21) had a figure-of-eight suture placed through the anterior vaginal cuff and intentionally into the bladder. Animals in group 2 (n = 11) were treated in an identical manner but care was taken to exclude the bladder when the suture was placed into the anterior vaginal cuff. Animals were put to death, and necropsy was performed 28 days after surgery. The bladder and vagina of each animal were harvested en bloc. Evidence of a fistula between the bladder and vagina was then determined in three distinct ways. Infant formula was infused into the bladder through a urethral catheter, and the vagina was inspected for leakage. Saline solution tinted with methylene blue was used in the same manner. Last, air was injected through the catheter into the bladder with the en bloc vagina and bladder preparation submerged in water. The vagina was observed for air leakage manifest by bubble formation.
The two groups were comparable in regard to weight gain, intraoperative complications, and postoperative complications. One animal in each group died. Neither had a surgical complication directly related to the suture placement. During inspection of the vagina and bladder no animal was noted to have a vesicovaginal fistula.
A suture placed through the bladder during closure of the vaginal cuff after transabdominal hysterectomy, as an isolated event, does not appear to be associated with formation of postoperative vesicovaginal fistula.
本研究的目的是确定经腹子宫切除术中阴道残端闭合时缝线穿过膀胱是否与术后膀胱阴道瘘的形成有关。
选用未生育的雌性新西兰白兔进行本研究。研究方案经机构动物使用与护理委员会批准。动物按照适当的指南饲养并维持在密西西比大学医学中心的动物设施中。32只动物按2:1的比例随机分为两组。所有动物均接受经腹子宫切除术。第1组（n = 21）的动物在前阴道残端放置8字缝线并有意穿过膀胱。第2组（n = 11）的动物接受相同方式的处理，但在将缝线放入前阴道残端时注意避开膀胱。术后28天处死动物并进行尸检。将每只动物的膀胱和阴道整块取下。然后通过三种不同的方法确定膀胱与阴道之间有无瘘管。通过尿道导管向膀胱内注入婴儿配方奶，检查阴道有无渗漏。以同样的方式使用亚甲蓝染色的生理盐水。最后，将导管插入膀胱注入空气，同时将整块取下的阴道和膀胱浸于水中，观察阴道有无因气泡形成而出现的漏气情况。
两组在体重增加、术中并发症和术后并发症方面具有可比性。每组各有1只动物死亡。均无与缝线放置直接相关的手术并发症。在检查阴道和膀胱时，未发现任何动物有膀胱阴道瘘。
经腹子宫切除术后阴道残端闭合时缝线穿过膀胱，作为一个独立事件，似乎与术后膀胱阴道瘘的形成无关。
