Johnson Paul M, O'Connor Brenda I, Cohen Zane, McLeod Robin S
IBD Research Unit, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Dis Colon Rectum. 2005 Jun;48(6):1249-53. doi: 10.1007/s10350-004-0872-9.
Pouch-vaginal fistula is an uncommon but serious complication after ileal pouch anal anastomosis. The management of pouch-vaginal fistulas is challenging and a number of treatment options exist. The purpose of this study was to examine the outcomes after various procedures for pouch-vaginal fistula performed at our institution.
Patients who were treated for pouch-vaginal fistula at Mount Sinai Hospital were identified from a prospectively maintained database. Demographic, disease history, treatment, and outcomes data were obtained. Treatment success was defined as no recurrence of the fistula with a functioning pouch and no ileostomy.
Since November 1982, 24 of 619 (3.9 percent) women who had primary ileal pouch-anal anastomosis performed at Mount Sinai Hospital developed a pouch-vaginal fistula. Five women had ileal pouch-anal anastomosis performed at another institution and were referred for management of their pouch-vaginal fistula. Local and/or combined abdominoperineal repairs were performed in 22 of 29 patients. Combined abdominoperineal repairs were associated with a higher success rate than that of local perineal repairs (52.9 vs. 7.9 percent, respectively, at 10 years after repair; p = 0.035). Overall, 50 percent (11/22) of patients who underwent surgical repair of a pouch-vaginal fistula had a successful result with a functioning pouch and no recurrence of the fistula, and 21 percent (6/29) of patients required pouch excision.
The management of pouch-vaginal fistula after ileal pouch-anal anastomosis is associated with a high recurrence rate. Combined abdominoperineal repair appears to offer better results than those of local procedures.
贮袋-阴道瘘是回肠贮袋肛管吻合术后一种罕见但严重的并发症。贮袋-阴道瘘的治疗具有挑战性，存在多种治疗选择。本研究的目的是探讨在我们机构进行的各种贮袋-阴道瘘手术的疗效。
从一个前瞻性维护的数据库中识别出在西奈山医院接受贮袋-阴道瘘治疗的患者。获取人口统计学、疾病史、治疗和结局数据。治疗成功定义为瘘管无复发、贮袋功能正常且无回肠造口术。
自1982年11月以来，在西奈山医院接受初次回肠贮袋肛管吻合术的619名女性中有24名（3.9%）发生了贮袋-阴道瘘。5名女性在另一机构进行了回肠贮袋肛管吻合术，并因贮袋-阴道瘘的管理前来就诊。29例患者中有22例进行了局部和/或联合腹会阴修补术。联合腹会阴修补术的成功率高于局部会阴修补术（修补术后10年分别为52.9%和7.9%；p = 0.035）。总体而言，接受贮袋-阴道瘘手术修复的患者中有50%（11/22）获得了成功的结果，贮袋功能正常且瘘管无复发，21%（6/29）的患者需要切除贮袋。
回肠贮袋肛管吻合术后贮袋-阴道瘘的治疗复发率高。联合腹会阴修补术似乎比局部手术效果更好。
