D'Ambrosio Giancarlo, Intini Gianfrancesco, Picchetto Andrea, Campo Salvatore, Balla Andrea, Quaresima Silvia, Paganini Alessandro M, Lezoche Emanuele
Ann Ital Chir. 2015;86:456-8.
Rectovesical Fistula (RVF) is a rare major surgery complication. Despite different techniques have been proposed as yet there is still no standard treatment. Transanal Endoscopic Microsurgery provides a magnified three-dimensional vision and it is less invasive than the traditional surgical procedure used in RVF treatment.
A 62 years-old man, who developed a rectovesical fistula after laparoscopic radical prostatectomy, underwent TEM-assisted RVF repair by full-thickness excision and both bladder and rectal wall suture. The patients had a temporary ileostomy
The patient could ambulate on day one, was fed on day three and was discharged on day 10 with the indwelling bladder catheter left in place. The ileostomy was taken down and the catheter removed three months later when colonoscopy and cystoscopy showed no rvf recurrence.
From 2004, only ten cases of TEM-assisted treatment of RVF are reported with three recurrences and good results even in patients who had already undergone previous surgical attempts. TEM is safe and effective. It provides a tension free suture line on healthy tissue with adequate hemostasis and it may be a good alternative in the treatment of rectovesical fistula.
Endoscopic Surgery, Microsurgery, Recto-vesical Fistula, Transanal Endoscopic.
直肠膀胱瘘（RVF）是一种罕见的重大手术并发症。尽管已经提出了不同的技术，但仍没有标准的治疗方法。经肛门内镜显微手术提供放大的三维视野，并且比用于治疗RVF的传统手术侵入性更小。
一名62岁男性，在腹腔镜根治性前列腺切除术后发生直肠膀胱瘘，接受了经肛门内镜显微手术辅助的RVF修复术，采用全层切除及膀胱和直肠壁缝合。患者进行了临时回肠造口术。
患者术后第1天即可下床活动，第3天开始进食，第10天出院，留置膀胱导管。3个月后，结肠镜检查和膀胱镜检查显示无RVF复发，此时拆除回肠造口并拔除导管。
自2004年以来，仅报道了10例经肛门内镜显微手术辅助治疗RVF的病例，其中3例复发，即使是在先前已进行过手术尝试的患者中也取得了良好的效果。经肛门内镜显微手术安全有效。它在健康组织上提供无张力的缝合线，止血充分，可能是治疗直肠膀胱瘘的一种良好替代方法。
内镜手术；显微手术；直肠膀胱瘘；经肛门内镜
