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目的 分析直肠阴道瘘的致病因素,总结直肠阴道瘘的手术治疗经验.方法 回顾性分析上海交通大学医学院附属瑞金医院2002年2月至2007年10月间收治的39例直肠阴道瘘的病因及治疗情况.结果 39例病人全部采用手术治疗,其中37例治愈,2例因癌症晚期死亡,随访3个月至5年未见复发.结论 直肠阴道瘘原因复杂,要根据原发疾病、瘘管位置高低、瘘管直径粗细等具体情况来选择最佳术式,并把握好手术时机.对复发性直肠阴道瘘采用带血管蒂的全层肠片以及直肠推进瓣技术可明显提高手术成功率.此外术中应仔细操作,以预防及减少医源性直肠阴道瘘的发生.

Experience on the treatment of rectovaginal fistula:an analysis of 39 cases

??Objective:To investigate the cause?? prevention and clinical strategy of rectovaginal fistula (RVF) which may improve its therapeutic effect?? Methods:The clinical data of 39 patients with rectovaginal fistula were reviewed retrospectively from February 2002 to October 2007 in Ruijin Hospital,Shanghai Jiaotong University School of Medicine??The causes and the ways of treatment were analyzed?? Results:Of all the 39 patients treated with operative corrections??37 patients were cured and achieves good results while 2 patients died due to the terminal stage of cancer??No recurrent fistula was identified with postoperative follow??up of 3 months to 5 years. Conclusion:Varieties of rectovaginal fistula can be reliably repaired with satisfactory therapeutic outcomes using different operative corrections??the choice of optimal procedures and timing of operation are important factors for successful surgery??Both the endorectal advancement flaps and patch of intestine provides an effective methods in repairing challenging recurrent rectovaginal fistula??Meticulous performance should be put emphasis in the surgical curative activities to decrease the incidence of iatrogenic rectovaginal fistula??