Soong Y, Lim P H
Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore.
Singapore Med J. 1997 Nov;38(11):475-8.
This is a retrospective study to determine differences in outcome and prognosis between patients with urological injuries treated immediately within 30 days by definitive repair and those in whom definitive treatment was delayed.
Patients who sustained urinary tract injuries after gynaecological surgery and who were subsequently referred to the Urological Department of (former) Toa Payoh Hospital during the period 1985-1991.
There were nine injuries sustained in eight patients: six to the ureters and three to the bladder. One patient had a double injury: a vesico-vaginal fistula and a uretero-vaginal fistula. There were six patients whose injuries were repaired within 30 days of the primary gynaecological operation. They stayed an average of 10-14 days in hospital and were discharged well. They were well both clinically and radiologically on follow-up. Two patients had initial drainage before definitive surgery was undertaken. One patient recovered fully but had to endure the morbidity of a prolonged, 3-month hospital stay. The other patient treated by simple diathermy for her vesico-vaginal fistula, never fully recovered, and subsequently defaulted follow-up.
The old dictum of waiting 3 to 6 months to allow oedema to subside, tissue planes to be re-established and the fistula to become smaller, before repair is attempted, should be reviewed. Recently acquired fistulae may be repaired definitively soon after diagnosis of the problem, with good results in competent hands, as supported in this series of patients studied. This shortens the length of hospital stay for the patients and alleviates much of the morbidity endured.
这是一项回顾性研究，旨在确定在30天内立即接受确定性修复的泌尿系统损伤患者与确定性治疗延迟的患者之间的结局和预后差异。
1985年至1991年期间，在妇科手术后遭受尿路损伤并随后转诊至（前）大巴窑医院泌尿外科的患者。
8例患者共发生9处损伤：输尿管损伤6处，膀胱损伤3处。1例患者有双重损伤：膀胱阴道瘘和输尿管阴道瘘。6例患者在初次妇科手术后30天内接受了损伤修复。他们平均住院10 - 14天，出院时情况良好。随访时临床和影像学检查均显示良好。2例患者在进行确定性手术前先行引流。1例患者完全康复，但不得不忍受长达3个月的住院带来的不适。另1例因膀胱阴道瘘接受简单透热疗法治疗的患者，从未完全康复，随后未进行随访。
对于在尝试修复之前等待3至6个月以使水肿消退、组织层面重新建立且瘘管变小的旧有说法，应重新审视。正如本系列研究的患者所支持的那样，最近形成的瘘管在诊断问题后不久即可进行确定性修复，在技术熟练的医生手中会取得良好效果。这缩短了患者的住院时间，并减轻了所忍受的许多不适。
