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作者为42例复杂性膀胱阴道瘘施行了尿瘘修补术。手术入路可经腹膜外或腹腔途径,横行切开膀胱顶部,双侧输尿管插入导管,在瘘孔周围缝牵引线,包括全部疤痕组织,广泛切除疤痕组织,尤其是以前曾做过修补手术的病人,切除必须达到血运丰富和健康的膀胱壁部位。广泛切除后,一般输尿管粘膜下段贴近切口边缘,仅个别病人需做输尿管移植。沿膀胱与阴道壁之间游离瘘孔周围组织,充分止住阴道壁出血,避免电灼止血。阴道壁作一层间断缝合,使其创缘翻向阴道腔内。应有足够缝线间距,以便引流膀胱与阴道壁之间可能形成的血肿。
The authors performed a fistula repair of 42 complicated vesico-vaginal fistulas. Surgical approach may be extraperitoneal or intraperitoneal approach, transverse incision of the top of the bladder, bilateral ureteral catheterization, the fistula hole around the traction line, including all scar tissue, extensive excision of scar tissue, especially in the past have done a repair operation Patients, resection must reach rich and healthy blood supply bladder wall parts. After extensive resection, the lower ureter usually close to the edge of the incision, only a few patients need ureter transplantation. Along the bladder and vaginal wall between the free fistula around the tissue, fully stop bleeding vaginal wall, to avoid electrocautery to stop bleeding. Vaginal wall for a layer of intermittent suture, so that the edge of its turn into the vaginal cavity. There should be enough sutures to drain the possible hematoma between the bladder and the vaginal wall.