腹腔镜辅助低位直肠癌全系膜切除术后直肠阴道瘘的预防与治疗

目的探讨腹腔镜辅助低位直肠癌全系膜切除术(laparoscopic-assisted total mesenteric excision,LATME)术后直肠阴道瘘(rectovaginal fistula,RVF)的预防与治疗。方法 2005-03-2013-03,共对179例女性低位直肠癌患者行LATME,17例术后并发RVF,回顾性分析患者的临床资料,总结LATME术后并发RVF的预防及治疗措施。结果本组17例患者,RVF发生率为9.5%(17/179),低位单纯型瘘70.6%(12/17),中位单纯型瘘29.4%(5/17),无高位及复杂性瘘。仅给予非手术治疗3例(17.6%),其中痊愈1例(33.3%),无效后采取手术修补2例(66.7%)。接受永久性横结肠双腔造瘘术2例(11.8%),症状缓解,瘘口未愈合。手术修补14例(82.4%),总治愈率85.7%(12/14),其中经阴道修补、经肛门修补、经肛门结合经阴道修补治愈率分别为0(0/1)、66.7%(2/3)、100%(10/10)。结论 LATME术后并发RVF多为术中损伤直肠阴道膈或局部感染所致,应积极预防。一旦发生,应积极选择手术修补。

Prevention and management of rectovaginal fistula of laparoscopic - assisted total mesenteric excision for lower rectal cancer

Objective To investigate the prevention and management of rectovaginal fistula of laparoscopic -assisted total mesenteric ex- cision for lower rectal cancer. Methods There were 179 female patients with lower rectal carcinoma who underwent laparoscopic - assisted total mesenteric excision between 2005/3 - 2013/3, the data of 17 cases with rectovaginal fistula following surgery were retrospectively analyse. Re- suits Of the 179 patients, 17 developed rectovaginal fistula clinically, an incidence of 9.5% （17/179）. Of these, lower simple leakage in 12 （70.6%）, middle simple leakage in 5（29.4% ）. They were cured by non - suegieal treatment in 3 cases（ 17.6）, the cure rate was 33.3% （I/3） ; permanent diverting stoma （ loop transverse colostomy ） in 2 cases （11.8% ） ; and surgical repair in 14 cases （82.4%）, The cure rates of transvaginal, peranum, peranum and transvaginal approaches were 0% （0/1） , 66.7% （2/3）, 100% （10/10） . Conclusion The most frequent causes of postoperative rectovaginal fistulas after 1 aparoscopic - assisted total mesenteric excision is the damadge of the jury of re- ctovaginal septum or the infection of anastomotic leakage. Surgical repair is the best method that can cure rectovaginal fistulae.