Laparoscopic transabdominal transvesical vesicovaginal fistula repair
Laparoscopic transabdominal transvesical vesicovaginal fistula repair
复制标题
DOI：
10.1089/end.2006.20.240
复制
发表时间：
2006-04-01
影响因子：
2.7
通讯作者：
Lucente, VR
中科院分区：
文献类型：
--
作者：
Wong, C;Lam, PN;Lucente, VR
背景和目的：经腹经膀胱修补术已成为治疗难治性膀胱阴道瘘的标准方法。我们描述了一种腹腔镜经膀胱技术，最大限度地减少手术发病率，同时坚持经腹修复所描述的O 'Conner.Technique的原则：病人被放置在截石位置使用艾伦镫，和双边5 F开放式输尿管导管膀胱镜放置。使用四个腹腔镜端口，进入膀胱前间隙。将膀胱向下对瓣至瘘管，并在膀胱边缘放置留置缝线以暴露。切除瘘管和邻近的纤维化组织，用单层全层间断2-0薇乔缝线分别闭合膀胱和阴道。在膀胱和阴道的缝合线之间插入网膜瓣。在术后第一天和第二天依次取出输尿管导管。重力膀胱造影进行3周后，如果它是正常的，尿道catheter是removed.Results：这个程序已经进行了两个连续的病人谁失败了之前Latzko修复。两名患者术后2天出院，无并发症。在第一个病人和第二个39个月的随访41个月，没有瘘复发已经seen.Conclusions：腹腔镜经膀胱膀胱阴道瘘修复似乎是一个安全有效的程序，坚持经腹经膀胱瘘修复的原则，同时降低发病率和改善美观。需要继续随访，以确定其长期疗效相比，接受开放经腹和经阴道的方法。
Background and Purpose: Transabdominal transvesical repair has been the standard treatment for difficult vesicovaginal fistulae. We describe a laparoscopic transvesical technique that minimizes operative morbidity while adhering to the principles of transabdominal repair as described by O'Conner.Technique: The patient is placed in the lithotomy position using Allen stirrups, and bilateral 5F open-ended ureteral catheters are placed cystoscopically. Using four laparoscopic ports, the prevesical space is accessed. The bladder is bivalved down to the fistula, and stay sutures are placed at the bladder edges for exposure. The fistulous tract and adjacent fibrotic tissue are excised, and the bladder and vagina are closed separately with single layers of full-thickness interrupted 2-0 Vicryl sutures. An omental flap is interposed between suture lines in the bladder and vagina. The ureteral catheters are sequentially removed on the first and second postoperative days. A gravity cystogram is performed 3 weeks postoperatively; if it is normal, the urethral catheter is removed.Results: This procedure has been performed on two consecutive patients who had failed prior Latzko repairs. Both patients were discharged 2 days postoperatively without complications. At a follow-up of 41 months in the first patient and 39 months in the second, no fistula recurrence has been seen.Conclusions: Laparoscopic transvesical vesicovaginal fistula repair appears to be a safe and effective procedure that adheres to the principles of a transabdominal transvesical fistula repair while decreasing morbidity and improving cosmesis. Continued follow-up is required to determine its long-term efficacy compared with the accepted open transabdominal and transvaginal approaches.