子宮皮膚廔管：案例報告及文獻回顧

Utero-cutaneous fistula: case report and literature review

子宮皮膚廔管是一個罕見情形尤其發生在剖腹產後，且容易在最初被誤診。我們搜尋了 1974-2019 年在pubmed 上的文章並回顧關於他們的臨床病史、診斷工具及處理方式。50 歲女性有邊緣性卵巢漿液性腫瘤並接受了生育功能保留手術（雙側卵巢輸卵管切除、大網膜切除、雙側骨盆腔淋巴結擴清及主動脈旁淋巴結採樣），後續接受人工生殖成功懷上雙胞胎，並於35+3 週時因胎位不正及嚴重子癲前症接受剖腹產。術後兩個月病人抱怨傷口紅腫，在接受清創手術時懷疑形成皮膚子宮廔管，並在後續廔管攝影證實。由於完成分期手術及感染控制，病人後續接受全子宮切除及廔管切除手術。在前續原因包括敗血性流產及手術之後，遲發性症狀是子宮皮膚廔管常誤診的原因。核磁共振可以給予軟組織好的分辨率、避免輻射，及幫助釐清廔管位置及周邊組織的關係；處理原則不僅限於手術，並要考慮病人年紀、生育考慮及醫院設備來給病人提供最大利益的處置。

Utero-cutaneous fistula is a rare condition after operation especially cesarean section and could be misdiagnosed at the beginning. We searched the articles on Pubmed from 1974-2019 and did the review including their clinical history, diagnosis tool and management. A 50-year-old female with a history of ovarian borderline serous borderline tumor received a complete debulking surgery. Then, she was conceived with twin pregnancy via artificial fertilization and underwent cesarean section due to malpresentation & severe preeclampsia during pregnancy 35+3 weeks. She complained of swelling and erythematous change over the surgical scar. The utero-cutaneous fistula was suspected of wound debridement and was proved by a fistulogram. Owing to complete staging and infection control, she then received a total abdominal hysterectomy and fistula resection. Late onset of symptoms after previous event included septic abortion and previous surgery is the usual reason for misdiagnosis. Diagnosis by MRI provided good soft tissue resolution, avoids radiation, and helps in proper delineation of the fistulous tract and its relation to the surrounding viscera. Management is not limited to operation alone and could depend on patient age, fertility consideration and local facilities to create the best benefit for the patient.