Kniery Kevin, Johnson Eric K, Steele Scott R
Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA.
J Gastrointest Surg. 2015 Mar;19(3):570-4. doi: 10.1007/s11605-014-2719-6. Epub 2014 Dec 18.
Rectovaginal fistulas present a difficult problem that is frustrating for patients and surgeons alike. Surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with coloanal reconstruction. For recurrent or complex rectovaginal fistulas, especially in the setting of prior radiation, Crohn's disease, or large wounds, bringing in healthy tissue into the space provides an excellent opportunity for improved results. The bulbocavernosus muscle and its surrounding vascularized tissue pedicle, first described by Martius in 1928, is an excellent option for fistula closure. Surgeons caring for these patients should be aware of this technique and have it as one method in their operative armamentarium when faced with these challenging cases.
直肠阴道瘘是一个棘手的问题，这让患者和外科医生都感到沮丧。手术选择包括胶原塞、直肠内推进皮瓣、括约肌修复或结肠肛管重建切除等。对于复发性或复杂性直肠阴道瘘，尤其是在既往接受过放疗、患有克罗恩病或存在大伤口的情况下，将健康组织引入该区域可为改善治疗效果提供绝佳机会。球海绵体肌及其周围带血管蒂组织，由马蒂于1928年首次描述，是闭合瘘管的绝佳选择。治疗这些患者的外科医生应了解该技术，并在面对这些具有挑战性的病例时，将其作为手术手段之一。
