Aartsen E J, Sindram I S
Department of Gynecology, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam.
Eur J Surg Oncol. 1988 Apr;14(2):171-7.
Two local repair procedures, one without (9) and the other with (14) a bulbocavernosus muscle graft were performed on 20 patients with a radiation induced rectovaginal fistula. Four patients had two procedures successively. The initial success rate of both procedures was 7/9 and 14/14 respectively. Though the initial result of the bulbocavernosus graft was obviously better, in many of the local repair procedures, subclinical radiation damage progressed, resulting in recurrence of rectovaginal fistula (5), rectovesical fistula (4), pararectal abscess (2) etc. After a mean follow up of around 10 years, the success rate of fistula repair decreased to 5/9 and 13/14 and only 2/9 and 6/14 finally remained without a colostomy. A local repair operation should be restricted to carefully selected cases. The musculus gracilis is proposed as a better vascular graft. If the general condition of the patient does not allow more aggressive reconstructive procedures, fistula repair is better cancelled because there is a high risk of subsequent radiation damage.
对20例放射性直肠阴道瘘患者实施了两种局部修复手术，其中9例未进行球海绵体肌移植，14例进行了球海绵体肌移植。4例患者先后接受了两次手术。两种手术的初始成功率分别为7/9和14/14。尽管球海绵体肌移植的初始效果明显更好，但在许多局部修复手术中，亚临床放射性损伤仍在进展，导致直肠阴道瘘复发（5例）、直肠膀胱瘘复发（4例）、直肠旁脓肿（2例）等。平均随访约10年后，瘘管修复成功率降至5/9和13/14，最终仅2/9和6/14的患者无需进行结肠造口术。局部修复手术应仅限于精心挑选的病例。建议使用股薄肌作为更好的带血管移植物。如果患者的一般状况不允许进行更积极的重建手术，最好取消瘘管修复，因为后续发生放射性损伤的风险很高。
