探讨经膀胱途径修补膀胱阴道瘘手术时机的选择以及治疗效果。

回顾性分析2012年1月至2018年4月中山大学附属第三医院及外院会诊手术共21例膀胱阴道瘘患者的临床资料。患者年龄24～66岁，病程3个月至30年。所有患者均行膀胱镜检，单个瘘口16例、2个瘘口4例、3个瘘口1例，瘘口大小0.3～1.5 cm，瘘口位于输尿管口旁6例，膀胱底后壁9例，输尿管间嵴后方6例。

21例均行膀胱阴道瘘修补术，其中16例经膀胱途径，4例经膀胱联合经腹途径，1例经膀胱联合阴道途径。除子宫内膜癌术后辅助放疗引起者行膀胱联合阴道途径修补术后2个月仍出现少量漏尿外，其余20例经膀胱途径修补术均取得成功，随访1～65个月均无漏尿及输尿管损伤等并发症发生。

经膀胱途径修补膀胱阴道瘘是一种安全有效的方法，对于复杂性瘘，术中根据瘘口具体情况联合经腹或阴道进行修补，可以提高治愈率、减少并发症的发生。

To investigate the surgical timing and clinical efficacy of trans-bladder repair of vesicovaginal fistulae.

Clinical data of 21 patients who were diagnosed with vesicovaginal fistula in Lingnan hospital, the Third Affiliated Hospital of Sun Yat-sen University and local hospitals from January 2012 to April 2018 were retrospectively analyzed. The patients were aged 24-66 years. The course of disease was ranged from 3 months to 30 years. All patients underwent cystoscopy. Sixteen cases had a single fistula, two fistulae in 4 cases and three fistulae in 1 case. The fistulae were 0.3-1.5 cm in size. The fistulae were located adjacent to the ureteral orifice in 6 patients, posterior wall of the bladder floor in 9 cases and posterior interureteric ridge in 6 patients.

All 21 patients underwent the repair of vesicovaginal fistulae, including 16 cases via the bladder route, 4 via the bladder combined with abdominal route, and 1 via the bladder combined with vaginal route. One endometrial cancer patient experienced mild urine leakage at two months after the repair operation via the bladder combined with vaginal approach caused by adjuvant radiotherapy. The remaining 20 cases successfully completed the repair surgery. No urine leakage, ureteral injury or alternative complications occurred during postoperative 1-65 month follow-up.

Trans-bladder repair of vesicovaginal fistulae is an efficacious and safe treatment of complex fistulae. Intraoperatively, abdominal or vaginal repair can be integrated according to the status of fistulae to enhance the clinical efficacy and safety.