Clinical Analysis Of Double J-Tube In The Treatment Of Ureterovaginal Fistula After Hysterectomy

Objective:To study the clinical effect of double J tube in the treatment of ureterovaginal fistula after hysterectomy Methods:Data of patients with ureterovaginal fistula after hysterectomy admitted to our department from January 2012 to June 2018 were collected through medical record room,including hospitalization number,name,age,length of stay,past medical history,time of discovery of urinary leakage after operation,description of injury during operation,laboratory-related laboratory results(creatinine,etc.),intravenous pyelography and secretion.The data of 27 patients were collected,including 22 cases of double J catheter successfully indwelling,5 cases of failure of indwelling catheter and ureterovesical anastomosis.Successful catheterization patients ranged in age from 28 to 68,with an average age of 43.32(+12.73).Ureteral fistula was located on the left in 13 cases and on the right in 9 cases.Laparoscopic-assisted vaginal hysterectomy was performed in 7 cases,laparoscopic myomectomy in 5 cases,and laparoscopic extensive hysterectomy plus pelvic lymph node dissection in 10 cases.Vaginal leakage occurred 6 to 21 days after operation in all patients,with abdominal pain in 9 cases and fever in 3 cases.According to the number of double J tubes,the cases were divided into A and B groups,of which 12 cases were in group A and 10 cases were in group B.The follow-up period was from June 2018 to December 2018.Statistical analysis was made on the data collected above and a conclusion was drawn.Results: The healing rate of fistula in double J tube group was 80% higher than 75% in single double J tube group,but there was no significant difference.This may be related to the small number of cases.It is difficult to draw a definite conclusion at present.Further research is needed to increase the sample size to confirm it.There was no significant difference in creatinine between the two groups before and after operation,and there was no significant difference in creatinine difference between the two groups after operation.Comparing the hydronephrosis of the two groups before and after operation,the hydronephrosis of the single double J tube group after operation was lower than that before catheterization,and the difference was statistically significant(P < 0.05).The hydronephrosis in double J tube group was lower than that before catheterization(P < 0.05).Compared with the number of patients with ureteral stricture after operation,the incidence of ureteral stricture in the double J tube group(12.5%)was lower than that in the single double J tube group(33.3%).The difference was statistically significant(P < 0.05).Conclusion:Female ureterovaginal fistula patients with ureterovaginal stent drainage is safe and effective.It not only reduces urine exudation,speeds up the healing of fistula,but also avoids the damage of renal function and prevents infection.Ureteral stent drainage can alleviate hydronephrosis,protect renal function and improve inflammatory reaction in patients with non-healing fistula after catheterization,which is conducive to surgical treatment.Most of the patients with ureterovaginal fistula had no obvious early symptoms,such as abdominal distension,abdominal pain and lumbar acid,which were mistaken for surgical trauma.When the above symptoms occur in patients after uterine surgery,the occurrence of ureterovaginal fistula should be vigilant.Dual J-tube drainage is more effective and the incidence of ureteral stricture is lower after operation,but the long-term effect and mechanism need to be further verified by large samples.