CAJ | 학술논문

目的探讨腹腔镜下大网膜移位修补膀胱阴道瘘的可行性及效果. 方法回顾性分析2007年7月至2011年7月收治16例膀胱阴道瘘患者的资料.年龄34 ～ 72岁,平均48岁.病史1个月～30年,其中子宫术后并发症15例,节育环穿孔所致l例.16例均为单个瘘口,痿口直径＜1 cm者13例,＞1 cm者3例.瘘口位于阴道壁14例,位于宫颈处2例.16例均行经腹腔路径腹腔镜下大网膜移位局部填塞+常规膀胱阴道瘘分层缝合修补瘘口. 结果 16例手术均获成功,手术时间120～175 min,平均150 min；术中出血量50～300ml,平均120 ml；术后住院6～10d,平均8.5d；尿管留置14～21 d,平均17 d.无肠道损伤等严重并发症.术后随访3～45个月,平均23个月.治愈14例,好转l例,失败l例. 结论腹腔镜下大网膜移位修补膀胱阴道瘘具有损伤小、痛苦轻、效果较肯定等特点,大网膜局部填塞和精细的分层缝合是手术要点.
목적 탐토복강경하대망막이위수보방광음도루적가행성급효과. 방법 회고성분석2007년7월지2011년7월수치16례방광음도루환자적자료.년령34 ～ 72세,평균48세.병사1개월～30년,기중자궁술후병발증15례,절육배천공소치l례.16례균위단개루구,위구직경＜1 cm자13례,＞1 cm자3례.루구위우음도벽14례,위우궁경처2례.16례균행경복강로경복강경하대망막이위국부전새+상규방광음도루분층봉합수보루구. 결과 16례수술균획성공,수술시간120～175 min,평균150 min；술중출혈량50～300ml,평균120 ml；술후주원6～10d,평균8.5d；뇨관류치14～21 d,평균17 d.무장도손상등엄중병발증.술후수방3～45개월,평균23개월.치유14례,호전l례,실패l례. 결론 복강경하대망막이위수보방광음도루구유손상소、통고경、효과교긍정등특점,대망막국부전새화정세적분층봉합시수술요점.
Objective To evaluate the feasibility and efficacy of laparoscopic repair of vesicovaginal fistula (VVF) with omentum shift.Methods Sixteen VVF patients were reviewed retrospectively from July 2007 to July 2011,aged from 34 to 72 years with a mean age of 48 years.The history of leakage of urine ranged from 1 month to 30 years,of which 15 cases due to uterine operation complication and 1 case due to IUD perforation.All cases were single fistula,with the fistula diameter ＜ 1 cm in 13 cases and ＞ 1 cm in 3 cases.Fourteen cases of fistulas were in the vaginal wall,and 2 cases were in the cervix.Surgical techniques were transabdominal laparoscopic local displacement of the great omentum and conventional layered suture repair of vesicovaginal fistula.Results All surgeries were successful.The operation time was 120 -175 min,with an average of 150 min.The blood loss was 50 -300 ml,with an average of 120 ml.The postoperative hospital stay was 6 to 10 d,with an average of 8.5 d.The catheter indwelling time was 14 to 21 d,with an average of 17 d.During the period of follow-up for 3 to 45 months with an average of 23months,14 cases cured,1 case improved and 1 case failed.No major complications such as intestinal injury occurred.Conclusions Laparoscopic repair of VVF with great omentum shift has the characteristics of less damage,less pain and positive effect.The key points of the surgery are local filling of great omentum and delicate layered suture.