Zmora Osnat, Tulchinsky Hagit, Gur Eyal, Goldman Gideon, Klausner Joseph M, Rabau Micha
Colorectal Unit, Division of Surgery B, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel.
Dis Colon Rectum. 2006 Sep;49(9):1316-21. doi: 10.1007/s10350-006-0585-3.
This study was designed to assess the efficacy of gracilis muscle transposition in repairing rectovaginal and rectourethral fistulas.
Data were retrieved from a retrospective chart review of patients who underwent gracilis muscle transposition for fistulas between the rectum and urethra/vagina. All patients had fecal diversion as a preliminary or concurrent step to fistula repair. Follow-up data were gathered from outpatient clinic visits. Success was defined as a healed fistula after stoma closure.
Six females and three males, aged 30 to 64 years, underwent gracilis muscle transpositions from 1999 to 2005. One pouch-vaginal, three rectourethral, and five rectovaginal fistulas were repaired. The etiologies were Crohn's disease (n = 2), iatrogenic injury to the rectum during radical prostatectomy (n = 2), previous pelvic irradiation for rectal cancer (n = 2) or for cervical cancer (n = 1), recurrent perianal abscesses with fistulas (n = 1), and obstetric tear (n = 1). Seven patients underwent previous medical and surgical repair attempts. There were no intraoperative complications. Postoperative complications included perineal wound infection (n = 1) and at the colostomy closure (n = 2). There were no long-term sequelae. At a median follow-up period of 14 (range, 1-66) months since stoma closure, the fistula healed in seven patients. One patient refused ileostomy closure. One patient with severe Crohn's proctitis has a persistent rectovaginal fistula.
Gracilis muscle transposition is a viable option for repairing fistulas between the urethra, vagina, and the rectum, especially after failed perineal or transanal repairs. It is associated with low morbidity and a good success rate. Underlying Crohn's disease and previous radiation are associated with poor prognosis.
本研究旨在评估股薄肌转位术修复直肠阴道瘘和直肠尿道瘘的疗效。
通过回顾性病历审查，收集接受股薄肌转位术治疗直肠与尿道/阴道瘘患者的数据。所有患者在瘘管修复术前或术中均进行了粪便转流。随访数据通过门诊就诊收集。成功定义为造口关闭后瘘管愈合。
1999年至2005年，6名女性和3名男性，年龄30至64岁，接受了股薄肌转位术。修复了1例贮袋阴道瘘、3例直肠尿道瘘和5例直肠阴道瘘。病因包括克罗恩病（n = 2）、根治性前列腺切除术中直肠医源性损伤（n = 2）、既往直肠癌（n = 2）或宫颈癌（n = 1）盆腔放疗、复发性肛周脓肿伴瘘管（n = 1）和产科撕裂伤（n = 1）。7例患者此前曾尝试过药物和手术修复。术中无并发症。术后并发症包括会阴部伤口感染（n = 1）和结肠造口关闭时的并发症（n = 2）。无长期后遗症。自造口关闭后的中位随访期为14（范围1 - 66）个月，7例患者的瘘管愈合。1例患者拒绝回肠造口关闭。1例患有严重克罗恩病直肠炎的患者直肠阴道瘘持续存在。
股薄肌转位术是修复尿道、阴道与直肠之间瘘管的可行选择，尤其是在会阴或经肛门修复失败后。其发病率低，成功率高。潜在的克罗恩病和既往放疗与预后不良有关。
