Xiao-Bing Chen, Dai-Xiang Liao, Jun-Hui Yu, Cheng-Hua Luo, Department of General and Colorectal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
World J Gastroenterol. 2013 Oct 21;19(39):6625-9. doi: 10.3748/wjg.v19.i39.6625.
To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs).
Between May 2009 and March 2012, 11 female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled. Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage. Efficacy was assessed in terms of the success rate and surgical complications. SF-36 quality of life (QOL) scores and Wexner fecal incontinence scores were compared before and after surgery.
The fistulas healed in 14 patients after gracilis muscle transposition; the initial healing rate was 73.7%. Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5 patients: 4 healed and 1 failed, and postoperative fecal diversions were performed for the patient whose treatment failed. At a median follow-up of 17 mo, the overall healing rate was 94.7%. Postoperative complications occurred in 4 cases. Significant improvement was observed in the quality outcomes framework scores (P < 0.001) and Wexner fecal incontinence scores (P = 0.002) after the successful healing of complex RVFs or RUFs. There was no significant difference in SF-36 QOL scores between the initial healing group and irrigation-suction-assisted healing group.
Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs. QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.
评估腹直肌移位和术后冲洗-抽吸在治疗复杂直肠阴道瘘（RVF）和直肠尿道瘘（RUF）中的疗效。
2009 年 5 月至 2012 年 3 月，前瞻性纳入 11 例女性复杂 RVF 患者和 8 例男性 RUF 患者。所有患者均行腹直肌移位术，早期漏液患者行术后伤口冲洗-抽吸。根据成功率和手术并发症评估疗效。比较手术前后 SF-36 生活质量（QOL）评分和 Wexner 粪便失禁评分。
14 例患者经腹直肌移位后瘘口愈合，初始愈合率为 73.7%。5 例患者术后发生渗漏，行伤口持续冲洗-抽吸，其中 4 例愈合，1 例失败，治疗失败的患者行术后粪便转流术。中位随访 17 个月时，总体愈合率为 94.7%。术后发生并发症 4 例。复杂 RVF 或 RUF 成功愈合后，质量结局框架评分（P < 0.001）和 Wexner 粪便失禁评分（P = 0.002）显著改善。初始愈合组和冲洗-抽吸辅助愈合组的 SF-36 QOL 评分无显著差异。
腹直肌移位和术后冲洗-抽吸对治疗复杂 RVF 和 RUF 有较高的成功率。RVF 和 RUF 成功愈合后，生活质量和粪便失禁显著改善。
