Wexner Steven D, Ruiz Dan E, Genua Jill, Nogueras Juan J, Weiss Eric G, Zmora Oded
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Ann Surg. 2008 Jul;248(1):39-43. doi: 10.1097/SLA.0b013e31817d077d.
The aim of this study was to review our experience with gracilis muscle interposition for complex perineal fistulas.
A retrospective review of all patients who underwent repair of perineal fistula using the gracilis muscle between 1995 and 2007 was undertaken. Patients were divided into 2 groups according to the fistula type by gender: females (rectovaginal and pouch-vaginal) and males (rectourethral).
Gracilis interposition was performed in 53 patients. Seventeen women underwent 19 gracilis interpositions for 15 rectovaginal and 2 pouch-vaginal fistulas; 76% had a mean of (1-4) (mean of 2) prior failed attempt at repair. Eight patients experienced at least one postoperative complication. Two women required a second gracilis interposition. Thirty-three percent of the Crohn's disease-associated fistulas successfully healed; 75% without Crohn's successfully healed.Thirty-six males underwent gracilis interposition for rectourethral fistulas, mainly due to prostate cancer treatment; 13 (36%) had a mean of 1.5 (range 1-3) failed prior repairs. Seventeen patients experienced postoperative complications. The initial success rate in men with rectourethral fistulas was 78%. After successful second procedures in 8 patients, the overall clinical healing rate was 97%.
The gracilis muscle transposition is a safe and effective method of treating complex perianal fistulas.
本研究的目的是回顾我们使用股薄肌修复复杂性会阴瘘的经验。
对1995年至2007年间所有采用股薄肌修复会阴瘘的患者进行回顾性研究。根据瘘管类型和性别将患者分为两组：女性（直肠阴道瘘和袋状阴道瘘）和男性（直肠尿道瘘）。
53例患者接受了股薄肌植入术。17名女性因15例直肠阴道瘘和2例袋状阴道瘘接受了19次股薄肌植入术；76%的患者平均有（1 - 4次）（平均2次）先前修复失败的尝试。8名患者经历了至少一种术后并发症。2名女性需要再次进行股薄肌植入术。33%的克罗恩病相关性瘘管成功愈合；75%无克罗恩病的瘘管成功愈合。36名男性因直肠尿道瘘接受股薄肌植入术，主要是由于前列腺癌治疗；13例（36%）平均有1.5次（范围1 - 3次）先前修复失败。17名患者经历了术后并发症。男性直肠尿道瘘的初始成功率为78%。8名患者在第二次手术成功后，总体临床愈合率为97%。
股薄肌转位是治疗复杂性肛周瘘的一种安全有效的方法。
