Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
目的： 探讨带蒂腹直肌联合双侧输尿管经膀胱外引流治疗难治性膀胱阴道残端瘘的有效性和安全性。 方法： 收集2019年12月至2022年12月在河北医科大学第二医院和河南省肿瘤医院收治的难治性膀胱阴道残端瘘患者(8例)的临床资料，分析膀胱阴道残端瘘难治性的原因，采用带蒂腹直肌联合双侧输尿管经膀胱外引流治疗膀胱阴道残端瘘的手术方法，记录手术时间、出血量和临床效果。 结果： 8例患者的中位手术时间为150 min(120~180 min)，中位出血量为400 ml(200~600 ml)。8例患者围手术期内切口感染2例(清创换药延期愈合)，切口裂开2例(再次手术缝合切口愈合)，泌尿系感染2例(经抗感染痊愈)。术后随访6个月，8例患者膀胱阴道残端瘘均痊愈。 结论： 腹直肌联合双侧输尿管经膀胱外引流是治疗难治性膀胱阴道残端瘘切实而行的有效方法，可作为临床修复方法之一。.
Keywords: External drainage; Refractory; Tipped rectus abdominis; Ureter; Vesicovaginal fistula.