直肠前突皮瓣加脂肪脂肪填充（RAFAL）治疗根治性前列腺切除术后直肠尿道瘘。

Rectal advancement flap plus adipose lipofilling (RAFAL) for the treatment of rectourethral fistulas after radical prostatectomy.

机构信息

Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Clinica Chirurgica 1, Via Giustiniani 2, Padova, 35128, Italy.

Clinica Chirurgica I, Azienda Ospedaliera di Padovavia Giustiniani, 35128, Padua, Italy.

出版信息

Tech Coloproctol. 2019 Oct;23(10):1003-1007. doi: 10.1007/s10151-019-02078-8. Epub 2019 Sep 18.

DOI:10.1007/s10151-019-02078-8

PMID:31535239

Abstract

BACKGROUND

Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care.

METHODS

We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm).

RESULTS

After a median follow-up of 53 months (range 6-163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen.

CONCLUSIONS

In our patient population this new procedure was safe and effective.

摘要

背景

直肠尿道瘘（RUF）是根治性前列腺切除术后罕见但严重的并发症。已经采用了许多不同的方法，但没有一种方法成为标准治疗方法。

方法

我们介绍了我们治疗 7 例患者的系列病例，这些患者接受了经肛门直肠推进皮瓣加间充质干细胞注射，以促进瘘管愈合。间充质细胞是通过一种称为 LIPOGEMS 的新型机械装置获得的。我们将这种技术称为 RAFAL（直肠推进皮瓣加脂肪脂肪填充）。所有患者的 RUF 均是腹腔镜根治性前列腺切除术的并发症。瘘管大小从 0.3 至 0.5 厘米（中位数为 0.4 厘米）。

结果

在中位数为 53 个月（范围为 6-163 个月）的随访中，7 例患者中有 2 例出现 RUF 复发。在这两种情况下，在一种情况下，通过 York-Mason 技术成功治疗了复发，在另一种情况下通过重新 RAFAL 治疗了复发。RAFAL 的成功率为 71%（7 例中有 5 例）。初次 RAFAL 和再 RAFAL 的总成功率为 85.7%（7 例中有 6 例）。未观察到短期或长期并发症。