微创泌尿外科杂志

目的 比较机器人辅助、腹腔镜与开放手术修补膀胱阴道瘘（VVF）的疗效，并探讨影响疗效的相关因素。方法 回顾性分析2015年12月至2024年7月郑州大学第一附属医院单一病区单一术者进行的58例VVF患者的临床资料，其中机器人辅助10例（机器人组）、腹腔镜20例（腹腔镜组）和开放手术治疗28例（开放组），比较三组患者的手术指标和随访结果，探究VVF修补失败原因。结果 患者中位年龄为50(44,53)岁，中位病程为9(7.5,30)个月。其中50例（86.21%,50/58）因妇产科手术继发VVF;20例（34.48%,20/58）的瘘口位于膀胱三角区；18例（31.03%,18/58）有既往修补手术史；8例（13.79%,8/58）存在多发性瘘口，瘘口最大直径的中位数为0.6(0.5～1.5)cm。50例（86.21%,50/58）VVF修补成功，8例（13.79%,8/58）修补失败。开放组患者的病程长度[9(8,30)个月]长于机器人组[5(3,12)个月]和腹腔镜组[3(3,6)个月]，多次修补次数（46.43%,13/28）多于机器人组（30%,3/10）和腹腔镜组（10%,2/20），差异均有统计学意义（P<0.001、P=0.028）。开放组患者的手术时间（122 min）长于机器人组（87 min）和腹腔镜组（84 min），出血量（100 mL）多于机器人组（25 mL）和腹腔镜组（20 mL），差异均有统计学意义（P=0.003、P<0.001）。单因素Logistic回归分析表明，手术方式、瘘口大小、瘘口数量、瘘口覆盖材料、病程长度对VVF修补成功无统计学意义（P均>0.05）。VVF发生原因(P<0.001)、膀胱三角区瘘口(P=0.007)、影响创面愈合的因素(P=0.031)、术后并发症（P<0.001）与瘘口修补成功显著相关。结论 与开放手术相比，机器人辅助或腹腔镜手术修补VVF的手术时间短、术中出血量少，而手术成功率相似，是一种安全有效的VVF的修补方式。VVF发生原因、瘘口位置与影响创面愈合因素是瘘口修补成功的影响因素。

Objective To compare the therapeutic efficacy of robot-assisted, laparoscopic, and open surgical repair for vesicovaginal fistula(VVF), and to explore the related factors influencing the treatment outcome. Methods A retrospective analysis was performed on the clinical data of 58 VVF patients who underwent surgical repair by a single surgeon in a single ward of the First Affiliated Hospital of Zhengzhou University from December 2015 to July 2024. Among them, 10 cases were treated with robot-assisted surgery(robot-assisted group), 20 cases with laparoscopic surgery(laparoscopic group), and 28 cases with open surgery(open surgery group). The surgical indicators and follow-up outcomes were compared among the three groups, and the causes of VVF repair failure were investigated. Results The median age of the patients was 50(44,53) years, and the median disease duration was 8(3,12) months. Of all patients, 50 cases(86.21%,50/58) developed VVF secondary to gynecological surgery; 20 cases(34.48%,20/58) had fistulas located in the trigone of the bladder; 18 cases(31.03%,18/58) had a history of previous repair surgery; 8 cases(13.79%,8/58) had multiple fistulas, with the median maximum diameter of fistulas being 0.6(0.5-1.5) cm. A total of 50 cases(86.21%,50/58) achieved successful VVF repair, while 8 cases(13.79%,8/58) experienced repair failure. The open surgery group had a longer disease duration [9(8,30) months] than the robot-assisted group [5(3,12) months] and the laparoscopic group [3(3,6) months], and a higher rate of multiple previous repairs(46.43%,13/28 vs. 30%,3/10 and 10%,2/20), with statistically significant differences(P<0.001,P=0.028). The open surgery group also had a longer operative time(122 min vs. 87 min and 84 min) and greater intraoperative blood loss(100 ml vs. 25 ml and 20 ml) compared with the robot-assisted group and laparoscopic group, with statistically significant differences(P=0.003, P<0.001). Univariate Logistic regression analysis showed that surgical approach, fistula size, number of fistulas, fistula coverage material, and disease duration had no statistically significant effects on the success of VVF repair(all P>0.05). In contrast, the etiology of VVF(P<0.001), fistula located in the trigone of the bladder(P=0.007), factors affecting wound healing(P=0.031), and postoperative complications(P<0.001) were significantly correlated with the success of fistula repair. Conclusions Compared with open surgery, robot-assisted or laparoscopic surgery for VVF repair has shorter operative time, less intraoperative blood loss, and similar surgical success rate, which is a safe and effective method for VVF repair. The etiology of VVF, fistula location, and factors affecting wound healing are the key factors influencing the success of VVF repair.