Park Seong Oh, Hong Ki Yong, Park Kyo Joo, Chang Hak, Shin Jin Yong, Jeong Seung-Yong
Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Int J Colorectal Dis. 2017 Jul;32(7):1029-1032. doi: 10.1007/s00384-017-2784-x. Epub 2017 Feb 16.
Rectovaginal fistulas are difficult to treat completely, especially when patients present with a history of multiple surgeries and radiation therapy. We aimed to evaluate the efficacy of gracilis muscle flap transposition to treat rectovaginal fistula.
We performed a retrospective chart review of all gracilis muscle transposition cases and other procedures between January 2009 and July 2016.
Total 53 cases were reviewed. A total of 11 patients underwent gracilis muscle flap transposition for rectovaginal fistula repair, with 8 patients showing good results without recurrence (total success rate, 72.7%). Comparison of this patient group with patients who had undergone other surgical procedures for rectovaginal fistula repair showed that those who received a gracilis transposition flap had significantly higher average number of previous surgeries (2.18 ± 1.17 vs. 1.1 ± 1.25) and had previously undergone radiotherapy at a significantly higher rate (63.6 vs. 26.2%). Furthermore, none of our patients complained of donor site discomfort.
Based on these results, we recommend using the gracilis muscle flap for rectovaginal fistula repair in cases where there is a history of radiotherapy and had surgical failure more than twice.
直肠阴道瘘难以完全治愈，尤其是对于有多次手术和放射治疗史的患者。我们旨在评估股薄肌瓣转移治疗直肠阴道瘘的疗效。
我们对2009年1月至2016年7月期间所有股薄肌转移病例及其他手术进行了回顾性病历审查。
共审查了53例病例。共有11例患者接受股薄肌瓣转移修复直肠阴道瘘，其中8例效果良好，无复发（总成功率为72.7%）。将该患者组与接受其他直肠阴道瘘修复手术的患者进行比较，结果显示接受股薄肌转移瓣的患者既往平均手术次数显著更多（2.18±1.17比1.1±1.25），且既往接受放疗的比例显著更高（63.6%比26.2%）。此外，我们的患者均未抱怨供区不适。
基于这些结果，我们建议在有放疗史且手术失败超过两次的情况下，使用股薄肌瓣修复直肠阴道瘘。
