Protsenko V M, Dul'tsev Iu V, Salamov K N, Marchenko V K
Khirurgiia (Mosk). 1991 May(5):60-4.
The article discusses 15-year experience in the treatment of 280 patients with various forms of rectovaginal fistulas. The choice of the operative method was differentiated on basis of complex appraisal of the etiology of the disease, pronouncement of the cicatricial and inflammatory changes, the level of the communication, relation of the fistula to the sphincter ani, and the functional condition of the rectal obturator apparatus. Most of the patients were subjected to combined interventions--excision of the fistula and local myoplasty (62%). Pyoinflammatory phenomena were the most frequent complications (17.2%) in the immediate postoperative period. The late-term results were studied in 249 patients, recurrent fistulas were found in 10.4% of cases, postoperative sphincter ani incompetence which called for plastic operations was discovered in 2.4% of patients. A differentiated choice of the method of surgical intervention made it possible to reduce in the recent years the frequency of recurrent fistulas from 15.2 to 6.4%, and the postoperative incompetence of the sphincter ani from 4.4 to 2.2%.
本文讨论了对280例各种类型直肠阴道瘘患者进行治疗的15年经验。手术方法的选择是基于对疾病病因的综合评估、瘢痕和炎症变化的程度、瘘口的位置、瘘管与肛门括约肌的关系以及直肠闭孔装置的功能状况而进行区分的。大多数患者接受了联合干预——瘘管切除和局部肌成形术（62%）。脓性炎症现象是术后早期最常见的并发症（17.2%）。对249例患者进行了远期疗效研究，发现10.4%的病例存在复发性瘘管，2.4%的患者出现了需要进行整形手术的术后肛门括约肌功能不全。近年来，通过对手术干预方法的差异化选择，复发性瘘管的发生率从15.2%降至6.4%，术后肛门括约肌功能不全的发生率从4.4%降至2.2%。
