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直肠推进皮瓣修复直肠尿道瘘:20年经验

Rectal advancement flap repair of rectourethral fistula: a 20-year experience.

作者信息

Garofalo Thomas E, Delaney Conor P, Jones Sandra M, Remzi Feza H, Fazio Victor W

机构信息

Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio, USA.

出版信息

Dis Colon Rectum. 2003 Jun;46(6):762-9. doi: 10.1007/s10350-004-6654-6.

Abstract

PURPOSE

Several procedures have been described for the management of rectourethral fistula. There has been no consensus on the best method of repair. The aim of this study was to review our experience with treatment of rectourethral fistula, focusing on the outcomes of rectal advancement flap repair.

METHODS

Data collected included demographics, cause, procedure type, presentation, operative details, and morbidity. Telephone follow-up was conducted to evaluate functional outcome and quality of life.

RESULTS

From 1981 to 2001, 23 male patients (age, 54 +/- 15 years) were treated for rectourethral fistula. Fecal diversion alone was performed in seven patients (30 percent), and urinary diversion alone was performed in one patient (4 percent). Both fecal and urinary diversion were performed in 12 patients (52 percent), and no diversion was performed in 3 (13 percent). Four patients were managed conservatively with diversion only. Nineteen patients underwent definitive repair. Rectal advancement flap repair was used in 12 (52 percent) of the cases. Postoperative length of stay was 4.5 +/- 4 days. Patients were followed up for an average of 31 +/- 33.4 months. Rectal advancement flap achieved primary closure in 8 (67 percent) of 12 patients. There were four recurrences. Two patients underwent successful repeat repair, for a final success rate of 83 percent. Morbidity associated with rectal advancement flap was 8 percent (1/12 patients). Cleveland Global Quality of Life score averaged 0.82 +/- 0.13.

CONCLUSION

The rectal advancement flap provides an effective repair for rectourethral fistula. Successful repair can be achieved in a majority of patients with minimal morbidity, short length of stay, and a good postoperative quality of life.

摘要

目的

已有多种治疗直肠尿道瘘的方法被描述。对于最佳修复方法尚无共识。本研究的目的是回顾我们治疗直肠尿道瘘的经验,重点关注直肠推进皮瓣修复的效果。

方法

收集的数据包括人口统计学资料、病因、手术类型、临床表现、手术细节和发病率。通过电话随访评估功能结局和生活质量。

结果

1981年至2001年,23例男性患者(年龄54±15岁)接受了直肠尿道瘘治疗。仅行粪便转流的有7例患者(30%),仅行尿液转流的有1例患者(4%)。12例患者(52%)同时进行了粪便和尿液转流,3例(13%)未进行转流。4例患者仅通过转流进行保守治疗。19例患者接受了确定性修复。其中12例(52%)采用了直肠推进皮瓣修复。术后住院时间为4.5±4天。患者平均随访31±33.4个月。12例患者中有8例(67%)直肠推进皮瓣实现了一期愈合。有4例复发。2例患者成功接受了再次修复,最终成功率为83%。直肠推进皮瓣相关的发病率为8%(1/12例患者)。克利夫兰全球生活质量评分平均为0.82±0.13。

结论

直肠推进皮瓣为直肠尿道瘘提供了一种有效的修复方法。大多数患者可以实现成功修复,发病率低,住院时间短,术后生活质量良好。

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