Department of Colorectal Surgery, Royal Liverpool University Hospital, Liverpool, UK.
Colorectal Dis. 2011 Aug;13(8):918-20. doi: 10.1111/j.1463-1318.2010.02278.x. Epub 2010 Apr 5.
Recto-urethral fistulas are an uncommon, but devastating complication following rectal or urinary tract surgery. Repair is often difficult, and the optimal approach is unclear. We report our recent experience using an endorectal advancement flap.
A case note review of all patients undergoing repair of recto-urethral fistula in our institution was undertaken. Data on aetiology of the fistula, patient demographics, operative procedure and outcome both clinically and radiologically were extracted.
Between 2002 and 2008, six transanal rectal advancement flaps in five patients were carried out. Four had undergone a laparoscopic radical prostatectomy, without any radiotherapy. Two types of fistula (type 1 associated with severe intra-abdominal sepsis and type 2 associated with localized sepsis) were found, with faecal diversion being less likely with the latter. Four (80%) patients underwent successful primary repair, with one patient requiring a second procedure. Postoperative cystography confirmed closure of the fistula in all five patients, and no recurrence has been observed at a mean follow-up time of 11 months.
Rectal advancement flap is a simple, effective technique for iatrogenic recto-urethral fistula with minimal morbidity.
直肠-尿道瘘是直肠或泌尿道手术后一种罕见但严重的并发症。修复通常很困难，最佳方法尚不清楚。我们报告最近使用直肠内推进皮瓣的经验。
对我院所有接受直肠-尿道瘘修复的患者进行病例回顾。提取瘘管病因、患者人口统计学、手术过程和临床及放射学结果的数据。
2002 年至 2008 年间，五名患者中有四名接受了六例经肛门直肠推进皮瓣手术。其中四人接受了腹腔镜根治性前列腺切除术，未接受任何放疗。发现两种瘘管类型（与严重腹腔内感染相关的 1 型和与局部感染相关的 2 型），后者发生粪便分流的可能性较小。四名（80%）患者成功进行了一期修复，一名患者需要进行第二次手术。术后膀胱造影证实所有五名患者的瘘管均已闭合，在平均 11 个月的随访时间内未观察到复发。
直肠推进皮瓣是治疗医源性直肠-尿道瘘的一种简单、有效的方法，并发症少。
