Choi Ji Hye, Jeon Byeong Geon, Choi Sang-Gi, Han Eon Chul, Ha Heon-Kyun, Oh Heung-Kwon, Choe Eun Kyung, Moon Sang Hui, Ryoo Seung-Bum, Park Kyu Joo
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Bundang Jesaeng Hospital, Seongnam, Korea.
Ann Coloproctol. 2014 Feb;30(1):35-41. doi: 10.3393/ac.2014.30.1.35. Epub 2014 Feb 28.
A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF.
The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed.
The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion.
Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.
直肠尿道瘘（RUF）是手术、放疗或外伤引起的一种罕见并发症。虽然已经描述了多种治疗RUF的手术方法，但尚无一种被公认为首选方法。本研究的目的是回顾我们对RUF手术治疗的经验。
评估了2005年5月至2012年7月间由一名外科医生为6例男性RUF患者（平均年龄51岁）实施手术的结果。
RUF的病因中，4例为医源性（2例为直肠癌放疗后，1例为前列腺癌近距离放疗后，1例为膀胱结石手术后），2例为外伤性。5例患者初始治疗采用粪便转流。1例患者在进行确定性修复的同时进行了粪便转流。4例患者平均在12个月后进行了分期修复。对于简单、较小的瘘（n = 2）采用直肠推进皮瓣修复，对于复杂或复发性瘘采用皮瓣插入术（股薄肌皮瓣，n = 2；网膜瓣，n = 1）。股薄肌皮瓣插入术后患者出现尿道狭窄和尿失禁，但经简单治疗后得到缓解。平均随访期为28个月，所有5例接受确定性修复的患者（100%）瘘口均愈合。1例仅接受粪便转流后拒绝进一步确定性手术的患者，瘘口持续存在。
根据RUF的严重程度和复发情况，可采用相对简单的直肠推进皮瓣修复或更复杂的股薄肌或网膜瓣插入术来实现瘘口闭合。
