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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。
Objective To investigate the etiology, clinical features and treatment of bladder fistula. Methods The clinical data of patients with bladder fistula admitted to Peking Union Medical College Hospital from 1986 to 2010 were retrospectively analyzed. Results Bladder fistula was found in 25 cases. The main causes were surgery injury (12 cases, 48%), malignant tumor (6 cases, 24%) and chronic infection / inflammation (5 cases, 20% (5 cases, 20%), urinary tract irritation (11 cases, 44%), abdominal mass (7 cases, 28%) and drainage stool (9 cases, 36%). Cystoscopy (73%, 11/15), cystography (73%, 8/11) and CT (67%, 8/12) were the most common tests for the detection of bladder fistula. Eighteen patients (72%) underwent surgery. Incision infection occurred in 6 cases, anastomotic leak in 3 cases, fistula recurrence in 2 cases, and death in 5 cases (27.8%). Seven patients (28%) were given non-surgical treatment and five had fistula healing. Conclusion The main causes of bladder fistula are surgical injuries, malignant tumors and chronic infections / inflammation. CT, cystoscopy and colonoscopy are the preferred method of diagnosis of bladder fistula and finding the cause. Surgery is the main treatment, conservative treatment can try to use in some patients.