수술적 방법에 의해 치료된 한국여성 생식기 누공에 관한 연구

Abstract

Objective: The purpose of this is to estabilish the standard of surgical management of female genital fistula in Korea. Methods: From January of 1992 through December of 1997, 73 patients with female genital fistula who came to the Department of Obstetrics and Gynecology, Urology and General surgery of Severance Hospital were enrolled in this retrospective study. The 7 patients who had congenital cause and the 38 patients who received conservative management were excluded from this study. We invastigate relationship between the prognosis and cause of the fistula, the prognosis and location of the fistula and the surgical approach method and location of the fistula .Results: In spite of appropriate surgical treatment, fistula due to management of cervix cancer has the worst prognosis. The recurrence of the fistula after surgical repair was frequently found in bladder fundus and base. Transvaginal/transrectal approach is suitable for fistula which was located in lower vagina. Transabdominal approach is proper for fistula which was located in functionally important area, difficult to approach to vaginal/rectal route and in case of severe adhesion. Conclusion: The oncologists need to pay more attention when they perform the operation or radiotherapy in case of cervical cancer. The surgeons need to pay attention when they operate near bladder fundus and base and repair fistula located in that area. The surgical approach method should be decided by the location of the fistula, the functional importance of the area and the difficulty to approach.