Imperial College London and St Mark's Hospital, London, UK.
Colorectal Dis. 2013 Jul;15(7):871-7. doi: 10.1111/codi.12114.
Surgery is the mainstay of treatment for rectovaginal fistula (RVF). Published success rates vary with initial success being around 50% rising to 80% with repeated surgery. Fistulae in Crohn's disease are more likely to recur.
A retrospective study was performed of RVF repair carried out between 2003 and 2008 in a tertiary referral centre. Patients undergoing surgery for an RVF under the senior author during the study period were identified and their clinical notes were reviewed.
Thirty-five patients underwent 50 operations. The median age was 42 years and 83% were tertiary referrals. Two patients were lost to follow-up. Healing occurred in 19 (58%) of 33 patients after a mean of 1.4 operations. The median time to success was 11 (2.5-48) months. The 'curative' group had an overall success of 73% (19 of 26). Seventy-five per cent of non-inflammatory bowel disease patients and 67% of those with Crohn's disease had successful treatment of the RVF. Twenty-four of 35 patients (67%) underwent creation of a stoma. Sixteen of 24 (67%) were deemed fit for restoration of continuity. No demographic or disease related factors were found to influence healing.
Cure of RVF can be achieved by a range of surgical approaches including abdominal and anal. A variety of different anal techniques are necessary, depending on the integrity of the anal sphincter and the presence or absence of perineal descent/internal intussusception.
手术是治疗直肠阴道瘘（RVF）的主要方法。已发表的成功率各不相同，初次手术成功率约为 50%，再次手术成功率上升至 80%。克罗恩病相关的瘘管更有可能复发。
对 2003 年至 2008 年在三级转诊中心进行的 RVF 修复进行回顾性研究。在研究期间，由资深作者为 RVF 患者实施手术，确定并回顾其临床记录。
35 名患者进行了 50 次手术。中位年龄为 42 岁，83%为三级转诊患者。2 名患者失访。33 名患者中有 19 名（58%）在平均 1.4 次手术后愈合。中位治愈时间为 11 个月（2.5-48 个月）。“治愈”组的总体成功率为 73%（26 例中的 19 例）。非炎症性肠病患者的成功率为 75%，克罗恩病患者的成功率为 67%。35 名患者中有 24 名（67%）行造口术。24 名患者中有 16 名（67%）被认为适合连续性修复。未发现任何人口统计学或疾病相关因素影响愈合。
通过腹部和肛门等多种手术方法可以治愈 RVF。根据肛门括约肌的完整性以及会阴下降/内部套叠的存在与否，需要采用各种不同的肛门技术。
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