Bauer J J, Sher M E, Jaffin H, Present D, Gelerent I
Department of Surgery, Mount Sinai Medical Center, New York, NY 10029-6574.
Ann Surg. 1991 Feb;213(2):151-8. doi: 10.1097/00000658-199102000-00010.
The management of rectovaginal fistulae complicating Crohn's disease is difficult and often unsatisfactory. Between December 1983 and November 1988, 13 patients with Crohn's disease underwent repair of rectovaginal fistulae via a transvaginal approach. All patients had a diverting intestinal stoma either as part of the initial step in the staged management of intractable perianal disease or concurrent with the repair of the rectovaginal fistula. Each of the patients had low or mid septal fistulae; high fistulae generally are treated transabdominally and are not the focus of this discussion. Fistulae were eradicated in 12 of the 13 women and did not recur during the follow-up period, which averaged 50 months (range, 9 to 68 months). The only treatment failure was a patient who had a markedly diseased colon from the cecum to the rectum and a very low-lying fistula. It is concluded that a modified transvaginal approach is an effective method for repair of rectovaginal fistulae secondary to Crohn's disease.
克罗恩病并发直肠阴道瘘的治疗困难，且常常不尽人意。1983年12月至1988年11月期间，13例克罗恩病患者经阴道途径修复直肠阴道瘘。所有患者均有转流性肠造口，这要么是难治性肛周疾病分期治疗初始步骤的一部分，要么是与直肠阴道瘘修复同时进行。每位患者均有低位或中位间隔瘘；高位瘘一般经腹治疗，并非本次讨论的重点。13例女性患者中有12例瘘管得以根除，在平均50个月（范围9至68个月）的随访期内未复发。唯一的治疗失败病例是一名患者，其结肠从盲肠至直肠均有明显病变，且瘘管位置极低。结论是改良经阴道途径是修复克罗恩病继发直肠阴道瘘的有效方法。
