Hjern F, Goldberg S M, Johansson C, Parker S C, Mellgren A
Division of Surgery, Karolinska Institutet and Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
Colorectal Dis. 2007 Jun;9(5):438-42. doi: 10.1111/j.1463-1318.2006.01171.x.
Fistulae to the female genital tract are an infrequent but severe complication of diverticular disease. The purpose of this study was to evaluate treatment and outcome in patients with diverticular colo-genital fistulae.
Sixty women treated for diverticular fistulae (DF) to the female genital tract during 1992-2004 were identified. Clinic and operative charts were reviewed. Mean age was 70 years and mean follow-up time after surgery was 1 year.
Most common presenting symptoms were vaginal discharge of faeces or gas (95% of patients) and abdominal pain (43%). About 75% of patients had undergone a hysterectomy. Forty-six patients underwent at least one radiological contrast study and the fistula was demonstrated in 35 (76%) patients. Fifty-seven patients had surgery, and findings included colo-vaginal fistulae (n = 47), colo-uterine fistulae (n = 2) and multiple fistulae involving vagina and other organs (n = 8). A sigmoid resection and primary anastomosis was performed in 51 and a Hartmann procedure with colostomy in six patients. Sixteen (28%) patients experienced morbidity after surgery, including anastomotic dehiscence (n = 4) and ureteric injury (n = 3). There was no mortality.
Diverticular fistulae to the female genital tract usually occur in elderly patients with a prior hysterectomy. Radiological contrast studies demonstrate the fistulous tract in most cases. Sigmoid resection and primary anastomosis results in a satisfactory outcome in the majority of patients.
女性生殖道瘘是憩室病罕见但严重的并发症。本研究的目的是评估憩室结肠生殖道瘘患者的治疗及预后情况。
确定了1992年至2004年间因女性生殖道憩室瘘（DF）接受治疗的60名女性。回顾了临床和手术记录。平均年龄为70岁，术后平均随访时间为1年。
最常见的症状是粪便或气体从阴道排出（95%的患者）和腹痛（43%）。约75%的患者接受过子宫切除术。46名患者至少接受了一项放射学造影检查，35名（76%）患者显示有瘘管。57名患者接受了手术，发现包括结肠阴道瘘（n = 47）、结肠子宫瘘（n = 2）以及涉及阴道和其他器官的多发瘘（n = 8）。51名患者进行了乙状结肠切除和一期吻合术，6名患者进行了Hartmann手术并做了结肠造口术。16名（28%）患者术后出现并发症，包括吻合口裂开（n = 4）和输尿管损伤（n = 3）。无死亡病例。
女性生殖道憩室瘘通常发生在有子宫切除史的老年患者中。放射学造影检查在大多数情况下可显示瘘管。乙状结肠切除和一期吻合术在大多数患者中可取得满意的效果。
