Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Georgetown University School of Medicine, 106 Irving Street, NW Suite 405 South, Washington, DC 20010, United States.
Eur J Obstet Gynecol Reprod Biol. 2013 Nov;171(1):166-70. doi: 10.1016/j.ejogrb.2013.08.011. Epub 2013 Aug 12.
To report surgical outcomes of patients who underwent rectovaginal fistula (RVF) repair with a history of Crohn's disease utilizing several reconstructive techniques.
Retrospective case series of women (n=6) with Crohn's disease surgically treated with either vaginal or rectal advancement flaps. Demographic information and data specific to Crohn's disease at the time of surgery were collected. In addition, operative reports and postoperative follow-up visits were reviewed.
During the study period, six women with the diagnosis of Crohn's disease and RVF underwent surgical management. Five patients had a vaginal advancement flap (VAF) by Female Pelvic Medicine and Reconstructive Surgery and one patient was treated by the rectal advancement flap by Colorectal Surgery. The failure rate in our study population was 33% (2/6). Of note, two of the patients who had a successful VAF had a previous failure after RAF. In addition, four patients who had a repair via the transvaginal approach had a concomitant pedicled flap procedure (i.e. Martius or gracilis flap). The average follow-up for all our patients was 5 months (+/- 6.5 months). No patients failed if they received a VAF with a concomitant flap procedure.
This case series illustrates several techniques utilized for the repair of RVF in patients with Crohn's disease. The use of a bulbocavernosus flap during the primary repair of RVF in this patient population may be considered to bolster the rectovaginal septum.
报告利用多种重建技术治疗克罗恩病患者直肠阴道瘘（RVF）修复的手术结果。
对接受阴道或直肠推进皮瓣手术治疗的克罗恩病女性（n=6）进行回顾性病例系列研究。收集了手术时的人口统计学信息和与克罗恩病相关的数据。此外，还回顾了手术报告和术后随访情况。
在研究期间，6 名患有克罗恩病和 RVF 的女性接受了手术治疗。5 名患者接受了女性盆底医学和重建外科的阴道推进皮瓣（VAF），1 名患者接受了直肠推进皮瓣的结肠直肠手术。本研究人群的失败率为 33%（2/6）。值得注意的是，2 名成功进行 VAF 的患者在 RAF 后曾有过失败。此外，4 名经阴道入路修复的患者同时进行了带蒂皮瓣手术（即 Martius 或 gracilis 皮瓣）。所有患者的平均随访时间为 5 个月（+/-6.5 个月）。如果患者接受 VAF 并同时进行皮瓣手术，则不会失败。
本病例系列说明了几种用于治疗克罗恩病患者 RVF 的技术。在该患者人群中，在 RVF 的初次修复中使用球海绵体肌皮瓣可能有助于加强直肠阴道隔。
