直肠阴道瘘经阴道手术治疗探讨

目的探讨直肠阴道瘘（rectovaginal fistula，RVF）经阴道手术修补的方法及手术成功的关键。方法2007年2月～2013年4月，对13例RVF经阴道修补。其中4例为RVF二次修补术，3例有2个瘘孔。均于瘘口形成半年后手术，术中不切除瘘管，采用“向心性”分离，充分利用瘘口周围的组织填补加固创面。结果13例瘘口均顺利愈合，无须行结肠造瘘术。手术时间25～55rain，（35±15）min。随访0．5～7年，平均2．5年，无复发。结论直肠阴道瘘经阴道修补简单易行，术中无需切除瘘管，手术时机、术前准备、术式的选择、术后管理是直肠阴道瘘治疗成功的关键。

Transvaginai Repair for Rectovaginal Fistula

Objective To explore the feasibility of transvaginal approach vaginoplasty for rectovaginal fistula （RVF）. Methods A total of 13 patients with RVF were given transvaginal approach vaginoplasty from February 2007 to April 2013. Among the patients, there were 4 cases of secondary repair and 3 cases having two orifices. The operation was performed 6 months after fistula formation in all the cases. Without resection of fistula, the wound was repaired with the surrounding tissues after centripetal separation. Results All the 13 cases were successfully operated. No colostomy was required. The operation time was 25 -55 min （mean, 35 ±15 min）. All the cases were followed up for 0.5 - 7 years （mean, 2.5 years） without recurrence. Conclusions Transvaginal rectovaginal fistula repair is safe, effective and simple. Removal of fistula is unnecessary. The preoperative preparation, selection of operative methods, and postoperative management are the key to a successful treatment.