Pelvic Floor Unit, Department of Colorectal Surgery-Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
J Gastrointest Surg. 2010 May;14(5):824-9. doi: 10.1007/s11605-010-1167-1. Epub 2010 Mar 16.
Crohn's-related rectovaginal fistulae have significant impact on quality of life including sexual function. The aim of this study was to obtain long-term follow-up of Crohn's related rectovaginal fistulae to assess variables that influence surgical success and determine its effects on quality of life and sexual function.
All women with Crohn's-related rectovaginal fistulas who underwent surgical repair from 1997 to 2007 were contacted for long-term follow-up. Variables assessed were age, body mass index, smoking, presence of active Crohn's disease, type of surgical procedure performed, use of perioperative seton or stoma, number of previous procedures, time interval between last repair and current repair, use of immunomodulators, and steroids. SF-12, Fecal Incontinence Quality-of-Life Scale, and Female Sexual Function Index were used to assess quality of life and sexual function. Multivariable logistic regression model was used to identify variables associated with surgical failure.
Sixty-five women were identified at median follow-up of 44.6 months (interquartiles, 13.1-79.1) of which 30 patients (46.2%) were successfully healed. Methods of repair included advancement flap (n = 47), episioproctotomy (n = 8), colo-anal anastomosis (n = 7), and fibrin glue or plug (n = 3). Twenty-eight women (43.1%) were sexually active at follow-up, and of those, nine complained of dyspareunia, all within the unhealed group of patients. On multivariate analysis, only immunomodulators were associated with successful healing (p = 0.009). Smoking and steroids were associated with failure (p = 0.04). Sexual function and quality-of-life scores were comparable between healed and unhealed groups.
Crohn's-related rectovaginal fistulae are difficult to treat. Healing increased with use of immunomodulators; however, smoking and steroids were predictors of failure. Dyspareunia was higher in unhealed women.
克罗恩病相关直肠阴道瘘对生活质量有重大影响，包括性功能。本研究的目的是对克罗恩病相关直肠阴道瘘进行长期随访，以评估影响手术成功的变量，并确定其对生活质量和性功能的影响。
所有接受手术修复的克罗恩病相关直肠阴道瘘女性患者，均在 1997 年至 2007 年间接受了长期随访。评估的变量包括年龄、体重指数、吸烟、活动性克罗恩病的存在、手术类型、围手术期挂线或造口的使用、既往手术次数、上次修复与当前修复之间的时间间隔、免疫调节剂和类固醇的使用。使用 SF-12、粪便失禁生活质量量表和女性性功能指数评估生活质量和性功能。使用多变量逻辑回归模型来确定与手术失败相关的变量。
在中位随访时间为 44.6 个月（四分位距，13.1-79.1）时，共确定了 65 名女性患者，其中 30 名患者（46.2%）成功治愈。修复方法包括推进皮瓣（n = 47）、会阴切开术（n = 8）、结肠直肠吻合术（n = 7）和纤维蛋白胶或塞（n = 3）。28 名女性（43.1%）在随访时具有性行为，其中 9 名女性存在性交困难，均为未治愈组患者。多变量分析显示，只有免疫调节剂与成功愈合相关（p = 0.009）。吸烟和类固醇与失败相关（p = 0.04）。治愈组和未治愈组的性功能和生活质量评分相当。
克罗恩病相关直肠阴道瘘很难治疗。免疫调节剂的使用可增加愈合率；然而，吸烟和类固醇是失败的预测因素。未治愈的女性性交困难发生率较高。
