探讨腹腔镜乳头式输尿管膀胱再植及腹腔镜膀胱肌瓣管输尿管成形术治疗对于保守治疗无效的宫颈癌手术及放疗所致输尿管阴道瘘患者的手术效果及临床价值。

回顾性分析2014年1月至2018年11月徐州医科大学附属医院泌尿外科诊治的15例在外院或我院试行输尿管支架管置入失败的输尿管阴道瘘患者，15例患者均行CT尿路成像、膀胱镜等检查确诊，其中13例行腹腔镜下乳头式输尿管膀胱再植术，另2例因输尿管下段粘连较重无法分离而改行腹腔镜膀胱肌瓣管输尿管成形术，观察指标包括手术时间、出血量及术后并发症。

15例患者均行腹腔镜手术成功，无一例改开放或失败，平均手术时间146（95～208）min，出血量110（60～180）ml，术后3个月拔出双J管，随访3～12个月，均未出现漏尿、进展性肾积水等严重并发症。

腹腔镜手术治疗对于保守治疗无效的输尿管阴道瘘患者疗效确切、安全可靠，创伤小、出血少、恢复快、成功率高，可明显提高患者生活质量，值得临床推广，但需要娴熟的腹腔镜操作技巧及丰富的解剖学经验。

To investigate the surgical efficacy and clinical value of 1aparoscopic extravesical ureteral nipple reimplantation and laparoscopic bladder muscle flaps for patients with ureterovaginal fistula(UVF) secondary to cervical cancer surgery and radiotherapy while conservative treatment was invalid.

Fifteen UVF patients failed by ureteral stent placement in hospital were analyzied retrospectively from January 2014 to November 2018 in our department. All cases were diagnosed by CTU and cystoscopy. Among them, 13 patients accepted 1aparoscopic extravesical ureteral nipple reimplantation, while 2 patients underwent laparoscopic bladder muscle flaps due to severe ureteral adhesion. The operative time, intraoperative blood loss and postoperative complications were analyzed.

All 15 patients underwent laparoscopic surgery successfully. The average operation time was 146(95-208) min, the blood loss was 110(60-180) ml, and all patients removed double J tube 3 months after operation without serious complications such as leakage of urine and progressive hydronephrosis during follow-up 3 to 12 months.

Laparoscopic surgery owning the advantages of little damage, less bleeding, rapid recovery, higher success rate, is a safe and effective method for patients with UVF secondary to cervical cancer surgery and radiotherapy while conservative treatment is invalid. However, skillful laparoscopic operation skills and rich anatomical experiences are required.