Charúa Guindic Luis, Retama Velasco Leopoldo, Avendaño Espinosa Octavio
Unidad de colorpoctología, servicio de gastroenterología, Hospital General de México, OD.
Ginecol Obstet Mex. 2004 May;72:209-14.
Rectovaginal fistula, although infrequent, produces considerable discomfort to the patients and disables them in their social life.
To review and report the experience in the management of rectovaginal fistula in the Colon and Rectal Unit of the General Hospital of Mexico City, from January 1997 to December 2001.
A retrospective, observational and descriptive study was designed including all patients diagnosed with rectovaginal fistula, who had not been previously operated for this condition in the Colon and Rectal Unit of the General Hospital of Mexico City from January 1977 to December 2001.
Thirty-eight patients were included, aged between 17 and 70 years with a mean age of 24. The etiology of the rectovaginal fistulas was: obstetric trauma in 21 patients (55.2%), post-surgical in 5 (13.1%), traumatic in 5 (13.1%), after radiotherapy in 5 (13.1%) and malignant in 2 (5.2%).
Rectovaginal fistula treatment relies on fistula classification (simple or complex), its location, and damage or not to the sphincter mechanisms and prior surgical repair.
The most frequent surgical approach was the creation of a fourth degree perineum laceration and reconstruction (45.7%), followed by the advancement flap (25.7%). Complex fistulas were handled with a stoma. The surgical approach of rectovaginal fistula must rely on etiologic, anatomic and physiologic basis.
直肠阴道瘘虽不常见，但会给患者带来极大不适，并使其社交生活受限。
回顾并报告1997年1月至2001年12月间墨西哥城综合医院结肠直肠科治疗直肠阴道瘘的经验。
设计一项回顾性、观察性和描述性研究，纳入1977年1月至2001年12月间在墨西哥城综合医院结肠直肠科诊断为直肠阴道瘘且此前未因该病接受过手术的所有患者。
共纳入38例患者，年龄在17岁至70岁之间，平均年龄24岁。直肠阴道瘘的病因如下：产科创伤21例（55.2%），术后5例（13.1%），外伤5例（13.1%），放疗后5例（13.1%），恶性肿瘤2例（5.2%）。
直肠阴道瘘的治疗取决于瘘管分类（简单或复杂）、其位置、括约肌机制是否受损以及既往手术修复情况。
最常用的手术方法是会阴Ⅳ度裂伤修复重建（45.7%），其次是推进皮瓣（25.7%）。复杂瘘管采用造口术处理。直肠阴道瘘的手术方法必须基于病因、解剖和生理基础。
