Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hopitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, France.
Colorectal Dis. 2011 Jun;13(6):e112-5. doi: 10.1111/j.1463-1318.2011.02544.x.
Many surgical approaches have been described for the treatment of low rectovaginal fistulae (LRVF); however, all are associated with a high recurrence rate and a poor function. The Martius flap technique was first described in 1928 and has since been modified for the treatment of LRVF. The aims of this study were to evaluate the short- and long-term results of the Martius flap procedure.
Twenty patients who underwent the Martius flap procedure between 2000 and 2010 were retrospectively included. Operative results and morbidity were evaluated. Quality of life (SF-12 score), quality of sexual life [Female Sexual Function Index (FSFI) score] and anal continence (Wexner score) were determined.
Crohn's disease was the predominant aetiology (n = 8, 40%). The Martius flap was mostly harvested from the left side (n = 14, 66.7%). The morbidity rate was 15% (n = 3), and the mean hospital stay was 7.7 ± 3.7 days. At a mean follow up of 35 months, the success rate was 65%. Seven patients still had an LRVF: in patients with Crohn's disease the success rate was 50% (4/8). Fifteen patients (75%) answered the three questionnaires. Quality of life score was in the normal range: physical component summary score (PCS: 46.7 ± 9) and mental component summary score (MCS: 44.7 ± 11.3). The median (range) FSFI score was 5 (2-31.7). Eight patients (53%) deemed cured suffered no incontinence. The Wexner score was significantly higher in the presence of a persisting LRVF (2.6 ± 5.5 vs 13.4 ± 3.78) (P = 0.0018). Use of a right-sided flap was associated with a higher success rate (P = 0.0442).
The Martius flap procedure for LRVF, had a success rate of about 60% and a low morbidity.
许多外科手术方法已被用于治疗低位直肠阴道瘘（LRVF）；然而，所有这些方法都与高复发率和较差的功能有关。Martius 皮瓣技术于 1928 年首次描述，此后已被修改用于治疗 LRVF。本研究的目的是评估 Martius 皮瓣手术的短期和长期结果。
回顾性纳入 2000 年至 2010 年间接受 Martius 皮瓣手术的 20 例患者。评估手术结果和发病率。生活质量（SF-12 评分）、性生活质量[女性性功能指数（FSFI）评分]和肛门控便能力（Wexner 评分）。
克罗恩病是主要病因（n=8，40%）。Martius 皮瓣主要取自左侧（n=14，66.7%）。发病率为 15%（n=3），平均住院时间为 7.7±3.7 天。平均随访 35 个月后，成功率为 65%。7 例患者仍有 LRVF：克罗恩病患者的成功率为 50%（4/8）。15 名患者（75%）回答了三个问卷。生活质量评分处于正常范围：生理成分综合评分（PCS：46.7±9）和心理成分综合评分（MCS：44.7±11.3）。FSFI 评分中位数（范围）为 5（2-31.7）。8 名（53%）认为治愈的患者没有失禁。存在持续性 LRVF 时，Wexner 评分明显较高（2.6±5.5 与 13.4±3.78）（P=0.0018）。使用右侧皮瓣与更高的成功率相关（P=0.0442）。
Martius 皮瓣手术治疗 LRVF 的成功率约为 60%，发病率低。
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