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膀胱阴道瘘在妇产科及泌外科临床工作中并非少见,我院在近15年中收治该类病人33例。膀胱阴道瘘明确诊断后均应手术治疗。但围手术期如果处理失当.常发生再次漏尿。分析病例造成手术失败的原因主要是感染及术后膀胱充盈扩张,导致修补后的切口撕裂。针对这些因素,笔者结合自己的体验.提出膀胱阴道瘘病人围手术期处理几点意见供同道参考。1 术前检查和处理 明确诊断,目的是了解漏口的大小、位置,有无阴道内其它疾病.以利手术方案的设计。全身各重要器官的检查,了解各重要器官对手术的承受力,特别要注意了解有无泌尿系结核、糖尿病、低蛋白营养不良。有泌尿系结核要先抗痨治疗半年以上。糖尿病术前要先控制血糖于正常范围,营养不良要予纠正。手术时机宜选择尿漏后6月以上,如合并直肠阴道瘘,宜先解决直肠瘘,再择期治疗膀胱瘘。手术前会阴消毒.用1％洁尔灭冲洗阴道3天,术前3天抗生素治疗。嘱病人多饮水使膀胱得到冲洗。
Bladder vaginal fistula in the obstetrics and gynecology and clinical work of urology is not uncommon, our hospital in the past 15 years, 33 patients were admitted to such patients. Bladder vaginal fistula should be diagnosed after surgery. However, perioperative improper handling, often happen again leaking urine. Analysis of cases caused by surgical failure is mainly due to infection and postoperative bladder filling expansion, resulting in repair of incision tear. In response to these factors, the author combined his own experience. Put forward a few opinions on perioperative treatment of vesicoureteral fistula for fellow reference. A preoperative examination and treatment of a clear diagnosis, the purpose is to understand the size of the leak, location, with or without other diseases within the vagina to facilitate the design of surgical options. The examination of vital organs of the whole body to understand the bearing capacity of the vital organs on the operation, with particular attention to understand the presence or absence of urinary tuberculosis, diabetes, low protein malnutrition. Urinary TB should first anti-tuberculosis treatment for more than six months. Diabetes preoperative control of blood glucose in the normal range, malnutrition to be corrected. Surgery should choose the timing of urinary leakage more than 6 months, such as the merger of rectovaginal fistula, should first solve the rectal fistula, and then elective treatment of bladder fistula. Preoperative disinfection of the perineum. Wash vagina with 1% benzalkonium bromide for 3 days, 3 days before the antibiotic treatment. Instruct the patient to drink more water to flush the bladder.