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題 名 | Enterovesical Fistula: 10 Years Experience=腸與膀胱瘻管:十年的經驗 |
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作 者 | 謝榮鴻; 陳維熊; 姜正愷; 林資琛; 林楨國; 徐弘; | 書刊名 | 中華醫學雜誌 |
卷 期 | 59:5 1997.05[民86.05] |
頁 次 | 頁283-288 |
分類號 | 416.245 |
關鍵詞 | 腸與膀胱瘻管; 尿糞症; 泌尿道感染; Enterovesical fistula; Fecaluria; Urinary tract infection; |
語 文 | 英文(English) |
中文摘要 | 背景:造成腸與膀胱(瘺)管管的原因包括惡性腫瘤、大腸憩室炎、手術後放射線治療、或外傷。確切的診斷是相當困難的,而治療的方法也是非常複雜的。本文的目的在於探討本病最適切的診斷方法及討論不同的治療方式對於其預後的影響。 方法:自1986至1995年,共有30個病人至本院就診。所有病人的資料,包括年齡、性別、症狀、原發疾病、診斷方法、發病位置、治療方式、及併發症等,均加以分析及討論。 結果:再發性泌尿道感染(73%)是最常見的症狀,其次是尿糞症(43%)及經直腸排尿(40%)。最常見的病因是惡性腫瘤(36%),其次是手術後放射線治療(17%)及醫療引起的傷害(17%)。診斷的方法以膀胱X光攝影(90%)、大腸鋇劑灌腸攝影(75%)、及膀胱鏡(69%)較為敏感。最好發的位置在直腸(52%),其次是乙狀結腸(39%)。 結論:聯合膀胱X光攝影、大腸鋇劑灌腸攝影、或膀胱鏡的檢查,幾乎所有的病人都可得到正確的診斷。手術方式的選擇是依照病人的身體健康狀況及原發疾病的情形而不同,單期手術治療只適合於身體健康狀況良好的病人,並且沒有腹膜炎或腸阻塞的情形。 |
英文摘要 | Background: Enterovesical fistula is a relatively uncommon complication of pelvic malignancies, diverticulitis of the colon, postoperative irradiation or trauma. Early diagnosis of enterovesical fistula is difficult and its management, complicated. The main purpose of this study is to investigate the most appropriate diagnostic method and to discuss the choice among different surgical managements. Methods: From 1986 to 1995, 30 patients with enterovesical fistula were diagnosed and treated at Veterans General Hospital-Taipei. The records were reviewed retrospectively with regard to symptoms, primary disease process, diagnostic studies, management, complications, mortality and follow-up. Results: Recurrent urinary tract infection (UTI) accounted for 73% and was the most common presenting symptom. Fecaluria (43%) and urine per rectum (40%) were another two common presenting symptoms. The major cause of these cases was malignancy (36%), followed by postoperative radiotherapy (17%) and iatrogenic injury (17%). Most of these cases were diagnosed by cystography (90%), barium enema (75%) or cystoscopy (69%). The rectum (52%) was the most common site involved, followed by the sigmoid colon (39%). The surgical management was individualized for each patient according to the general condition and the disease process. Conclusions: By combining the results of cystography, barium enema and cystoscopy, diagnosis of enterovesical fistula can be established in almost all cases. Single-stage operation for enterovesical fistula should be limited to those patients in good nutritional state and without severe inflammation, radiation injury, intestinal obstruction, other major medical problem, advanced malignancy or old age. |
本系統中英文摘要資訊取自各篇刊載內容。