Hilton P, Ward A
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):189-94. doi: 10.1007/BF01901602.
The aim of the study was to determine the epidemiological background, clinical details and surgical outcome of patients presenting with urogenital fistulae to St Luke's Hospital, Uyo, and the associated VVF Unit at Mbribit Itam, Akwa Ibom State, Nigeria, between January 1970 and December 1994. A retrospective review of hospital operating theater records and case notes was carried out. Clinical details and outcome were assessed for the total cohort of 2484 patients. Epidemiological data were extracted from the case notes of 715 patients presenting between January 1990 and December 1994. Of these 92.2% were of obstetric etiology, 80.3% following neglected obstructed labor, 6.9% following cesarean section, and 5.0% followed ruptured uterus; 4.4% followed pelvic surgery and the remaining 3.4% of miscellaneous causes included malignancy, coital injury, infection and trauma; 8% had a coexisting rectovaginal fistula or third-degree perineal tear. Only 37.3% of patients were aware of their age; the median age of this group was 28 years. Literacy was difficult to judge reliably, although 29% were able to sign their name. Parity ranged from 0 to 17, and only 31.4% of fistulae related to first pregnancies. Although 73.1% were delivered in hospital, in 97.1% labor was initially managed at home, with a traditional birth attendant, in a maternity home, or in church; 34.1% were delivered by cesarean section, although the live-birth rate was only 10.3% in the causative pregnancy. For a variety of reasons 124 women were not operated upon: 1954 underwent only one operation, giving a presumptive cure rate at first operation of 81.2%; 247 underwent two, 116 three, 32 four, and 11 five operations during the study period. The ultimate closure rate was 97.7%, with only 0.6% undergoing urinary diversion. The type and distribution of fistulae recorded in this series is consistent with previous series of largely obstetric fistulae from the developing world. Surgical cure rates are also comparable. The epidemiological background is at variance with previous reports in several respects; this may reflect biosocial differences in the population studied.
本研究旨在确定1970年1月至1994年12月期间，在尼日利亚阿夸伊博姆州乌约的圣卢克医院以及伊塔姆姆布里比特的相关膀胱阴道瘘治疗中心，因泌尿生殖瘘前来就诊的患者的流行病学背景、临床细节及手术结果。我们对医院手术室记录和病例进行了回顾性分析。对2484例患者的总体队列评估了临床细节和手术结果。从1990年1月至1994年12月期间就诊的715例患者的病例中提取了流行病学数据。其中，92.2%的病因是产科因素，80.3%继发于产程梗阻未得到处理，6.9%继发于剖宫产，5.0%继发于子宫破裂；4.4%继发于盆腔手术，其余3.4%的各种杂类病因包括恶性肿瘤、性交损伤、感染及外伤；8%同时存在直肠阴道瘘或三度会阴撕裂。只有37.3%的患者知道自己的年龄；该组患者的中位年龄为28岁。识字情况难以可靠判断，尽管29%的患者能够签名。产次从0到17不等，只有31.4%的瘘与首次妊娠有关。尽管73.1%的患者在医院分娩，但97.1%的患者最初是在家中、由传统接生员、在妇产院或在教堂进行分娩管理；34.1%的患者通过剖宫产分娩，尽管导致瘘的那次妊娠中的活产率仅为10.3%。由于各种原因，124名女性未接受手术：1954名女性仅接受了一次手术，首次手术的推定治愈率为81.2%；在研究期间，247名女性接受了两次手术，116名接受了三次手术，32名接受了四次手术，11名接受了五次手术。最终治愈率为97.7%，只有0.6%的患者接受了尿流改道术。本系列记录的瘘的类型和分布与之前来自发展中国家的主要为产科瘘的系列研究一致。手术治愈率也相当。流行病学背景在几个方面与之前的报告不同；这可能反映了所研究人群的生物社会差异。
