| Objective:To investigate the clinical effects of transurethral ureteral stent implantation and laparoscopic ureterovaginal replantation in the treatment of iatrogenic ureterovaginal fistula with delayed diagnosis.Methods:Patients with iatrogenic ureterovaginal fistula who were hospitalized in our hospital from January 2010 to December 2019 were diagnosed as ureterovaginal fistula according to medical history,leakage test and auxiliary examination before operation.all patients were secondary to surgery and diagnosed after operation.According to the operation method chosen by the patients,the patients were divided into two groups: TUS group and LUR group.Transurethral ureteroscopic ureteral stent implantation was performed in TUS group and laparoscopic ureteral bladder replantation was performed in LUR group.The clinical data of the patients were collected.The operation time,postoperative hospital stay,blood loss,reoperation,operative effectiveness,complications and postoperative stricture were compared between the two groups.The TUS group was analyzed within the group,and the location of the injury was compared and analyzed.The influence of diagnosis time and injury degree on the effect of TUS.RESULTS:A total of 72 cases were included,32 patients in the LUR group were operated successfully,25 patients in the TUS group were successfully intubated,and 15 patients failed in the catheterization group.There was no significant difference in age,BMI,left and right side,previous operation type and diagnosis time between the two groups(P > 0.05).The operation time,postoperative hospital stay and blood loss in the TUS group were significantly better than those in the LUR group(164.38 ±69.11 min VS 42.88 ±16.90min)(P < 0.01),(7.41 ±2.34 d VS 3.28 ±1.45d)(P <0.01),(163.41 ± 176.501 ml VS 14.13 ± 13.04ml)(P < 0.01).The rate of reoperation and the effective rate of operation in the LUR group were significantly better than those in the TUS group(6.25% VS 57.5%)(P < 0.01)and(96.88% VS50%)(P < 0.01).The incidence of complications in TUS group was lower than that in LUR group(0 VS 3.12%)(P > 0.05).The rate of ureteral stenosis in the LUR effective group was lower than that in the TUS effective group(3.33% VS 20%)(P >0.05).In 40 cases of TUS group,the operative effective rate of ≤ 2cm group was slightly higher than that of > 2cm group(50% VS 45.45%)(P > 0.05),and the operative effective rate of ≤ 14 days group was higher than that of > 14 days group(70.59% VS 34.78%)(P > 0.05),the operative effective rate of grade 2 group was higher than that of grade 3 group(75% VS 47.37%)(P > 0.05),and all of grade 4group were ineffective.Conclusions:1.Both LUR and TUS are safe and feasible surgical methods for the treatment of UVF,with good surgical safety and acceptable postoperative complications.2.High efficiency of LUR operation;It is a reliable surgical method to treat UVF.TUS has a low overall efficiency and cannot replace LUR surgery,but it has great advantages in hospital cost,operation time,blood loss,postoperative hospital stay and other aspects.3.The incidence of stenosis in TUS effectors was higher than that in LUR effectors.For TUS group,the earlier the diagnosis time is,the higher the operative effective rate is;there is no significant difference in the operative effective rate with different distance between the injury site and the ureteral orifice;the effective rate of TUS in patients with mild injury is higher than that in patients with severe injury,but more convincing research results still need more sample size research.Both LUR and TUS are safe and feasible surgical methods for the treatment of UVF,with good surgical safety and acceptable postoperative complications. |
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