直肠癌术后直肠阴道瘘的治疗策略

 目的　探讨低位直肠癌术后直肠阴道瘘（RVF）的发生原因、治疗策略、治疗方式和临床结果。方法　回顾性分析低位直肠癌术后RVF 14例女性患者的临床资料，根据治疗策略分成A组（传统治疗10例）、B组（戊酸雌二醇结合非手术治疗4例），比较两组治疗策略的临床结果。结果　A组10例患者中，8例行横结肠造口，其中7例RVF自然愈合，愈合时间为2～6个月，确定愈合后行横结肠造口还纳、消化道重建；2例因拒绝转流性造口而行非手术治疗，其中1例在 4个月时RVF自然愈合。B组4例患者中3例在1.5～2个月时自然愈合，1例因继发于直肠吻合口瘘，治疗2周期后RVF无愈合迹象，遂行横结肠造口，并在随访中。结论　RVF是中低位直肠癌术后少见但比较严重的并发症，采取戊酸雌二醇结合非手术治疗策略，不仅可以明显促进RVF的自然愈合，而且能大大缩短其愈合时间；转流性造口可在治疗失败后补充使用。

Treatment strategy of rectovaginal fistula after rectal cancer operation

Objective　To investigate the cause, therapeutic strategy, methods of treatment and clinical results for the rectovaginal fistulas (RVF) after rectal cancer operations. Methods　The clinical data of 14 female patients with RVF after rectal cancer operations were examined retrospectively. According to therapeutic strategy, all patients were divided into two groups, A group and B group, which were seperately performed traditional treatment, and progynova in combination with non-operative treatment. Results　Among 10 patients in A group, 8 patients were performed feacal diversion stoma, and 7 patients with RVF cured naturally, then performed colostomy reversal and restoration of bowel continuity, the other 2 cases were performed non-operative treatment for refusing feacal diversion stoma. Among 4 patients in B group, 3 cases with RVF healed naturally during 1.5 to 2 months, one case secondary to rectal anastomosis was performed feacal diversion stoma for rectovaginal fistula without signs of healing. Conclusion　RVF is a rare but serious complication after resection of rectal carcinoma, which is taken by the treatment strategy of progynova in combination with non-operative treatment, not only can promote the natural healing of RVF obviously, but also can shorten the healing time greatly. Feacal diversion stoma can be used while the treatment is failure.