Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands.
J Gastrointest Surg. 2012 Aug;16(8):1559-65. doi: 10.1007/s11605-012-1919-1. Epub 2012 Jun 1.
According to literature, colonic resection with a primary anastomosis and no defunctioning ileostomy is a safe treatment for colovesical or colovaginal fistula of diverticular origin. This study investigates the outcome of surgery for this patient group in a regional hospital.
Patients were obtained from a prospective database in the period 2004-2011. Several variables were investigated for their relation with surgical outcome.
A colovesical (n = 35) or colovaginal (n = 5) fistula was diagnosed in 18 men and 22 women. The mean age was 69 years (range, 45-90). A rectosigmoid resection with primary anastomosis was performed in 32 patients. Fourteen patients received a defunctioning ileostomy. Eight patients were treated with a Hartmann procedure. Overall 30-day treatment-related morbidity and mortality was 48 and 8 %, respectively. Major morbidity, because of anastomotic leakage, was mainly observed in the primary anastomosis group without a defunctioning ileostomy. Morbidity and mortality were associated with high body mass index, diabetes, use of corticosteroids, and American Society of Anesthesiologists classification, though not significantly.
One should be liberal in the use of a defunctioning ileostomy in case of a primary anastomosis after colonic resection for a diverticular fistula, in order to prevent high morbidity rates due to anastomotic leakage.
根据文献，结直肠切除并一期吻合而不预防性回肠造口术是治疗源于憩室的结肠膀胱或结肠阴道瘘的安全治疗方法。本研究调查了一家地区医院中该患者群体的手术结果。
患者数据从 2004 年至 2011 年的前瞻性数据库中获取。研究了几个变量与手术结果的关系。
18 名男性和 22 名女性被诊断为结肠膀胱（n=35）或结肠阴道（n=5）瘘。平均年龄为 69 岁（范围，45-90 岁）。32 名患者接受了直肠乙状结肠切除术和一期吻合术。14 名患者接受了预防性回肠造口术。8 名患者接受了 Hartmann 手术。总体而言，30 天内治疗相关的发病率和死亡率分别为 48%和 8%。主要的发病率是由于吻合口漏，主要发生在没有预防性回肠造口术的一期吻合组。发病率和死亡率与高体重指数、糖尿病、皮质类固醇的使用和美国麻醉医师协会分类有关，但无统计学意义。
在结肠切除术后行一期吻合治疗憩室性瘘时，应更自由地使用预防性回肠造口术，以防止由于吻合口漏而导致的高发病率。
