直肠阴道瘘的手术治疗

目的总结直肠阴道瘘的手术治疗经验。方法1995年3月—2008年9月,收治各种原因所导致的直肠阴道瘘32例,根据导致直肠阴道瘘的原因与时间以及瘘管的部位与范围,分别采用直接缝合术、瘘管切除＋直接缝合术和瘘管切除＋局部阴道黏膜瓣转移修复术治疗。结果1例因放射性损伤所致的直肠阴道瘘,采用瘘管切除＋局部阴道黏膜瓣转移修复术治疗,因瘘管周围受放射性损伤的组织未被完全切除,于术后14 d伤口开裂,遂转肛肠外科行直肠切除、结肠肛门吻合术。本组其余患者伤口均一期愈合,未发生任何并发症;术后6个月常规随访结果显示,修复处阴道黏膜光滑,感觉和运动正常,无复发。结论根据导致直肠阴道瘘的原因与时间、瘘口的大小选择相应的手术治疗方法有助于提高手术成功率。

Surgical Treatment of Rectovaginal Fistula

Objective To sum up the experience of surgical treatment of rectovaginal fistula.Methods From March 1995 to September 2008,32 patients with rectovaginal fistula caused by various reasons were treated in our department.According to the reason and time to give rise to rectovaginal fistula and the site and range of fistula,direct suture,fistulectomy and direct suture or transplantation of local mucosal flap from vagina were selected respectively to treat rectovaginal fistula.Results One case of rectovaginal fistula caused by radioation injury was treated with fistulectomy and transplantation of local mucosal flap,the incision fissured on the 14th day after operation because the tissues around fistula injuried by radioation didn＇t be clearred thoroughly.This patient was transferred to anal and intestinal surgery to accept rectectomy and colon-anal anastomosis.The incisions of others in this group healed on the first stage,and no complication appearred.The follow-up results after six months post-operation showed that the mucosa of vagina was smooth,sensory and motor function were normal,and recurrence didn＇t occurred.Conclusion It is helpful to improve the successful rate of operation to select surgical method according to the reason and time to give rise to rectovaginal fistula and the area of fistula.