Schlöricke E, Zimmermann M, Hoffmann M, Laubert T, Nolde J, Hildebrand P, Bruch H-P, Bouchard R
Universitätsklinikum Schleswig-Holstein Campus Lübeck, Allgemeinchirurgie, Lübeck, Deutschland.
Zentralbl Chir. 2012 Aug;137(4):390-5. doi: 10.1055/s-0031-1283884. Epub 2012 Apr 2.
The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis.
Between 1 / 2000 and 1 / 2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data.
In a timespan of ten years 36 patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n = 21) and earlier surgical measures (n = 6). Moreover tumour-associated fistulas (n = 5) and fistulas with unknown genesis (n = 4) were seen. As surgical techniques anterior resection (n = 21), transrectal flap plasty (n = 7), subtotal colectomy (n = 3), pelvine exenteration (n = 2) and rectal exstirpation (n = 1) were used. The closure of the vaginal lesion was performed by single suture (n = 25), flap plasty (n = 6), transvaginal omental plasty (n = 2) and posterior vaginal plasty (n = 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12 months (6 - 36). Within this timespan 6 patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n = 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence).
The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.
直肠阴道瘘是一种病因多样的罕见疾病。其发病机制似乎预示着手术治疗的范围和预后结果。本研究的目的是介绍治疗直肠阴道瘘的不同手术技术及其与发病机制相关的结果。
收集2000年1月至2010年1月期间直肠阴道瘘患者的数据。回顾性分析包括传记和既往史数据以及临床参数、一般和特殊并发症及术后数据。
在十年时间里，共治疗了36例直肠阴道瘘患者。最常见的病因是炎症性疾病（n = 21）和既往手术史（n = 6）。此外，还发现了肿瘤相关瘘（n = 5）和病因不明的瘘（n = 4）。手术技术包括前切除术（n = 21）、经直肠皮瓣成形术（n = 7）、次全结肠切除术（n = 3）、盆腔脏器清除术（n = 2）和直肠切除术（n = 1）。阴道病变的闭合采用单纯缝合（n = 25）、皮瓣成形术（n = 6）、经阴道网膜成形术（n = 2）和阴道后壁成形术（n = 1）。所有患者均进行网膜成形术以安全分隔相关区域。低位瘘（<6 cm）患者采用经会阴网膜成形术治疗。中位随访时间为12个月（6 - 36个月）。在此期间，6例患者出现严重并发症[急性呼吸窘迫综合征、吻合口漏、术后出血、瘘复发（n = 3）]。3例患者在术后死亡（小脑梗死、与克罗恩病相关的败血症并发症、肿瘤复发导致的多器官功能衰竭）。
直肠阴道瘘的发病机制是切除范围大小的重要预测指标，切除范围可从简单切除到脏器清除术。为实现最佳治疗，手术干预需要纳入多学科治疗理念。
