Songne K, Scotté M, Lubrano J, Huet E, Lefébure B, Surlemont Y, Leroy S, Michot F, Ténière P
Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
Colorectal Dis. 2007 Sep;9(7):653-6. doi: 10.1111/j.1463-1318.2007.01232.x.
The treatment of ano- or rectovaginal fistula is still difficult. The use of the Martius flap is well described as an adjunctive technique in their repair. We report our experience of a modified Martius flap in the management of ano- or rectovaginal fistula.
This is a retrospective study of 14 women presenting with an anovaginal (n = 9) or rectovaginal fistula (n = 5). All were treated by a modified Martius graft. The aetiology included Crohn's disease (n = 7), ulcerative colitis (n = 4), radio-induced (n = 1), obstetric (n = 1) and villous tumour (n = 1).
All 14 fistulas healed within the 3 months after surgery. Subsequently, two patients with Crohn's disease required an abdominoperineal resection owing to progressive anal lesions. Two other patients experienced faecal incontinence which improved with functional rehabilitation treatment.
A modified Martius flap is a valuable option in the treatment of ano- or rectovaginal fistula. In the case of Crohn's disease, however, the prognosis depends primarily on subsequent clinical evolution of the condition.
肛管直肠阴道瘘的治疗仍然具有挑战性。Martius皮瓣作为一种辅助技术在其修复中已有详细描述。我们报告了改良Martius皮瓣在肛管直肠阴道瘘治疗中的经验。
这是一项对14例患有肛管阴道瘘（9例）或直肠阴道瘘（5例）女性患者的回顾性研究。所有患者均接受改良Martius移植治疗。病因包括克罗恩病（7例）、溃疡性结肠炎（4例）、放疗所致（1例）、产科因素（1例）和绒毛状肿瘤（1例）。
所有14例瘘管在术后3个月内愈合。随后，两名克罗恩病患者因肛门病变进展需要行腹会阴联合切除术。另外两名患者出现大便失禁，经功能康复治疗后有所改善。
改良Martius皮瓣是治疗肛管直肠阴道瘘的一种有价值的选择。然而，对于克罗恩病患者，预后主要取决于病情的后续临床进展。
