Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria.
Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years' experience in southeast Nigeria.
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DOI：
10.1007/bf01901602
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发表时间：
1998-01-01
期刊：
影响因子：
--
通讯作者：
Ward, A
中科院分区：
文献类型：
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作者：
Hilton, P;Ward, A
这项研究的目的是确定1970年1月至1994年12月在尼日利亚Akwa Ibom州Mbribit Itam的圣卢克医院和相关的VVF单位就诊的泌尿生殖道瘘患者的流行病学背景、临床细节和手术结果。对医院手术室记录和病例记录进行了回顾。对2484名患者的临床细节和结果进行了评估。流行病学数据摘自1990年1月至1994年12月期间715名患者的病例记录。其中产科原因占92.2%，其中80.3%为产科原因，80.3%为忽视难产，6.9%为剖宫产，5.0%为子宫破裂，4.4%为盆腔手术，3.4%为其他原因，包括恶性肿瘤、性交损伤、感染和创伤，8%合并直肠阴道瘘或会阴Ⅲ度撕裂。只有37.3%的患者知道自己的年龄；这一群体的中位年龄为28岁。识字能力很难可靠地判断，尽管29%的人能够签名。产次从0到17，只有31.4%的瘘管与第一次怀孕有关。虽然73.1%的产妇是在医院分娩，但97.1%的产妇最初是在家里、在传统助产士的陪同下、在妇产科或在教堂分娩；34.1%的产妇是通过剖腹产分娩的，尽管原因妊娠的活产率只有10.3%。由于各种原因，124名妇女没有接受手术：1954人只接受了一次手术，第一次手术的推定治愈率为81.2%；247人在研究期间接受了两次手术，116次3次，32次4次和11次5次。最终闭合率为97.7%，仅0.6%行尿流改道。本系列中记录的瘘管的类型和分布与以前发展中国家的主要产科瘘管系列一致。手术治愈率也具有可比性。流行病学背景在几个方面与以前的报告不同；这可能反映了所研究人群的生物社会差异。
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.