Lowry A C, Thorson A G, Rothenberger D A, Goldberg S M
Department of Surgery, University of Minnesota Medical School, Minneapolis.
Dis Colon Rectum. 1988 Sep;31(9):676-8. doi: 10.1007/BF02552581.
The results of 81 endorectal flap advancements for simple rectovaginal fistulas are reported. Simple fistulas are defined as less than 2.5 cm in diameter, low or mid vaginal septum in location, and infectious or traumatic in origin. Essentially, the technique is advancement of a flap of mucosa, submucosa, and circular muscle over midline approximation of internal sphincter muscle. The mean patient age was 34 years old (range, 18 to 76 years). The causes were obstetrical injury (74 percent), perineal infection (10 percent), operative trauma (7 percent), and unknown (8 percent). Overall, the repair was successful in 83 percent of patients. Success correlated with the number of previous repairs, i.e., none: 88 percent success; one: 85 percent success; two: 55 percent success. There were 25 concomitant overlapping sphincteroplasty procedures. Only minor complications ensued, with no mortality. This repair is recommended for patients with no or one previous repair because of its lack of mortality, minimal morbidity, ease of concomitant sphincteroplasty, and avoidance of a colostomy. For patients with two or more earlier repairs, a muscle interposition should be considered.
报告了81例采用直肠内瓣推进术治疗单纯直肠阴道瘘的结果。单纯性瘘定义为直径小于2.5 cm、位于阴道中隔低位或中位、病因是感染性或创伤性的瘘。本质上，该技术是将黏膜、黏膜下层和环形肌瓣推进至内括约肌肌中线对合处。患者平均年龄为34岁（范围18至76岁）。病因包括产科损伤（74%）、会阴感染（10%）、手术创伤（7%）和不明原因（8%）。总体而言，83%的患者修复成功。成功率与既往修复次数相关，即未修复：成功率88%；一次修复：成功率85%；两次修复：成功率55%。有25例同时进行了重叠式括约肌成形术。仅出现轻微并发症，无死亡病例。由于该修复术无死亡风险、发病率极低、便于同时进行括约肌成形术且无需行结肠造口术，因此推荐用于未进行过修复或仅进行过一次修复的患者。对于进行过两次或更多次早期修复的患者，应考虑采用肌肉植入术。
