CAJ | 학술논문

目的：探讨膀胱瘘的病因、临床特点及治疗方法。方法回顾性分析北京协和医院1986-2010年住院诊治的膀胱瘘患者的临床资料。结果膀胱瘘25例，主要病因是手术损伤（12例，48%）、恶性肿瘤（6例，24%）和慢性感染/炎症（5例，20%），表现为粪尿（9例，36%）、气尿（5例，20%）、尿路刺激症（11例，44%）、腹部包块（7例，28%）、排水样大便（9例，36%）等。对膀胱瘘阳性发现率较高的检查是膀胱镜（73%，11/15），膀胱造影（73%，8/11）和 CT （67%，8/12）。18例（72%）患者接受手术，术后发生切口感染6例、吻合口漏3例、瘘复发2例；死亡5例（27.8%）。7例（28%）给予非手术治疗，5例瘘口愈合。结论膀胱瘘的病因主要是手术损伤、恶性肿瘤和慢性感染/炎症。 CT、膀胱镜和结肠镜是诊断膀胱瘘及寻找病因的首选方法。手术是其主要治疗方法，保守治疗可尝试用于某些患者。
목적：탐토방광루적병인、림상특점급치료방법。방법회고성분석북경협화의원1986-2010년주원진치적방광루환자적림상자료。결과방광루25례，주요병인시수술손상（12례，48%）、악성종류（6례，24%）화만성감염/염증（5례，20%），표현위분뇨（9례，36%）、기뇨（5례，20%）、뇨로자격증（11례，44%）、복부포괴（7례，28%）、배수양대편（9례，36%）등。대방광루양성발현솔교고적검사시방광경（73%，11/15），방광조영（73%，8/11）화 CT （67%，8/12）。18례（72%）환자접수수술，술후발생절구감염6례、문합구루3례、루복발2례；사망5례（27.8%）。7례（28%）급여비수술치료，5례루구유합。결론방광루적병인주요시수술손상、악성종류화만성감염/염증。 CT、방광경화결장경시진단방광루급심조병인적수선방법。수술시기주요치료방법，보수치료가상시용우모사환자。
Objective To clarify the etiology, clinical presentations, diagnostic confirmation and treatment of en-terovesical fistulae and genitourinary fistulae. Methods Twenty-five patients with enterovesical fistulae or genitourinary fistulae over a 24-year period were identified. Demographics, clinical presentations, aetiology and clinical outcomes were evaluated. Results Etiologies in this group of patients were post -operative iatrogenic injuries (12 cases, 48%), malignances (6 cases, 24%) and chronic inflammation (5 cases, 20%). The clinical presentations were fecaluria (9 cases, 36%), pneumaturia (5 cases, 20%), urinary irritation (11 cases, 44%), palpable mass (7 cases, 28%) and watery stool (9 cases, 36%). The detection rate of various investigations in identifying a fistula was cystoscopy (11/15, 73%), cystogra-phy (8/11, 73%), CT (8/12, 67%) in sequence. Eighteen patients underwent operations. Post-operation complication includ-ed wound incision infection (6 cases), anastomotic leakage (3 cases) and recurrence of fistula (2 cases). The mortality rate was 27.8%(5/18). Symptomatic cure could be achieved in 5 out of 7 patients treated with conservative treatment. Conclu-sion The major causes of enterovesical fistulae and genitourinary fistulae are iatrogenic injuries, malignances and chronic inflammation. CT, cystoscopy and colonoscopy should be the first-line investigations to detect a fistula and the underlying diseases. Operation is the treatment of choice. Conservative management can be attempted in selected patients.