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腹腔镜直肠癌根治术后漏致直肠膀胱瘘的保守治疗。

Conservative treatment of rectovesical fistula after leakage following laparoscopic radical resection of rectal cancer.

机构信息

Department of Gastrointestinal Surgery, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China.

Operation Department, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China.

出版信息

J Int Med Res. 2020 Apr;48(4):300060520914835. doi: 10.1177/0300060520914835.

Abstract

Rectovesical fistula (RVF) is a multifactorial complication that can be caused by different types of laparoscopic surgery, malignant tumor invasion, and chronic inflammation. However, RVF as a postoperative complication of laparoscopic radical rectal cancer is rare and serious. Here, we describe the case of a patient with RVF secondary to pelvic infection that was induced by anastomotic leakage. The patient was managed with conservative treatment, which included double-cavity cannula irrigation-drainage, indwelling balloon urethral catheter, treating the urinary tract infection, partial parenteral nutrition, and enteral nutrition. The patient was discharged after his symptoms had improved. In this case report, we provide a feasible scheme for patients with RVF that is induced by postoperative anastomotic fistula. Inflammatory, infectious, and thrombotic factors are presumable factors that are involved in RVF pathogenesis. These findings provide new directions for the study of RVF induced by anastomotic leakage after rectal cancer surgery. Conservative treatment may be an option in patients who want to avoid an ostomy.

摘要

直肠阴道瘘(RVF)是一种多因素并发症,可由不同类型的腹腔镜手术、恶性肿瘤侵袭和慢性炎症引起。然而,RVF 作为腹腔镜直肠癌根治术后的并发症较为少见且严重。在此,我们描述了 1 例因吻合口漏导致的盆腔感染引起 RVF 的病例。该患者接受了保守治疗,包括双腔套管冲洗引流、留置球囊导尿管、治疗尿路感染、部分肠外营养和肠内营养。患者症状改善后出院。在本病例报告中,我们为术后吻合口瘘引起的 RVF 患者提供了一种可行的治疗方案。炎症、感染和血栓形成因素可能与 RVF 的发病机制有关。这些发现为研究直肠癌术后吻合口漏引起的 RVF 提供了新的方向。对于希望避免造口的患者,保守治疗可能是一种选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e9/7137136/ae794f9b838e/10.1177_0300060520914835-fig1.jpg

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