Onodera H, Nagayama S, Kohmoto I, Maetani S, Imamura M
Department of Surgery and Surgical Basic Science, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Tech Coloproctol. 2003 Oct;7(3):198-202. doi: 10.1007/s10151-003-0035-3.
We created a novel surgical repair for intractable rectovaginal fistula and treated four patients who had previously undergone unsuccessful surgery. An X-shaped skin incision was made on the perineum, and then the rectum was carefully divided from the vagina. Defects of both the rectum and the vagina were closed with vertical mattress sutures. The external sphincter muscle also was approximated. The gluteus muscle was identified through another skin incision to the buttock, and cut at the attachment to the femur. Bilateral gluteus muscles were approximated at the midline of the perineum so that the vagina was sufficiently separated from the rectum. Established anorectal angle was 92.5 degrees (SD=6.4 degrees ). Mean resting pressure was 101.3 cm H2O (SD=13.1). All patients retained complete anal function without soiling. The unusual problem of erosion of the posterior vaginal wall with fistulation in a sexually active woman justifies greater efforts, and this surgical technique offers good prospects in this small group of patients.
我们为顽固性直肠阴道瘘开创了一种新型手术修复方法，并治疗了4例先前手术失败的患者。在会阴处做一个X形皮肤切口，然后小心地将直肠与阴道分离。直肠和阴道的缺损均用垂直褥式缝合关闭。外括约肌也进行了对合。通过臀部的另一个皮肤切口找到臀肌，并在其与股骨的附着处切断。双侧臀肌在会阴中线处对合，以使阴道与直肠充分分离。建立的肛管直肠角为92.5度（标准差=6.4度）。平均静息压力为101.3 cm H2O（标准差=13.1）。所有患者均保留了完整的肛门功能，无大便失禁。对于一名性活跃女性出现的伴有瘘管形成的阴道后壁糜烂这一特殊问题，需要付出更大的努力，而这种手术技术在这一小群患者中具有良好的前景。
