直肠阴道瘘管理的实践模式：来自盆腔研究网络学员的多中心综述
Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network.
作者信息
Oakley Susan H, Brown Heidi W, Yurteri-Kaplan Ladin, Greer Joy A, Richardson Monica L, Adelowo Amos, Lindo Fiona M, Greene Kristie A, Fok Cynthia S, Book Nicole M, Saiz Cristina M, Plowright Leon N, Harvie Heidi S, Pauls Rachel N
机构信息
From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; §Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ¶¶Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.
出版信息
Female Pelvic Med Reconstr Surg. 2015 May-Jun;21(3):123-8. doi: 10.1097/SPV.0000000000000162.
OBJECTIVES
Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States.
METHODS
This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected.
RESULTS
Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (<0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists.
CONCLUSIONS
In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (<0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
目的
直肠阴道瘘（RVF）常使人衰弱，且尚无既定的治疗方案。我们试图描述美国目前针对直肠阴道瘘的诊断和管理策略。
方法
这项经机构审查委员会批准的多中心回顾性研究纳入了12个地点。在5年期间使用国际疾病分类第九版编码来识别病例。收集直肠阴道瘘治疗的人口统计学资料、管理情况及结果。
结果
共识别出342份病历；176份（52%）符合纳入标准。平均（标准差）年龄为45（17）岁。病史包括高血压（21%）、癌症（17%）、克罗恩病（11%）和糖尿病（7%）。直肠阴道瘘常与产科创伤（42%）、感染/炎症（24%）和癌症（11%）相关。总体而言，大多数直肠阴道瘘为原发性（94%）、较小（0.5 - 1.5厘米；49%）、经括约肌型（31%），且通过阴道和直肠检查诊断（60%）。18%（32/176）最初采用保守治疗，中位持续时间为56天（四分位间距，29 - 168天），其中66%（21/32）病情缓解。期待治疗的直肠阴道瘘中近一半（45%）极小（<0.5厘米）。82%（144/176）的患者最初接受手术治疗，81%（117/144）病情缓解。手术方式包括单纯瘘管切除术（有或无Martius移植）（59%）、经括约肌修补术（23%）、横向经会阴修补术（10%）和开放手术（8%），其中87%的手术由泌尿妇科医生实施。
结论
在这项大型回顾性研究中，大多数原发性直肠阴道瘘接受了手术治疗，成功率超过80%。三分之二接受保守治疗的直肠阴道瘘自行缓解，其中大多数极小（<0.5厘米）。这些成功率可用于咨询，以帮助我们的患者就其治疗选择做出明智的决定。
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