Li Qiwei, Sun Jianhua, Yin Lu, Ji Fu
Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Oncol. 2021 Feb 19;11:549211. doi: 10.3389/fonc.2021.549211. eCollection 2021.
Rectovaginal fistula (RVF) occurs as a result of abnormal epithelialized connections between the rectum and vagina. Rectal cancer surgery remains the major cause of RVF. Here, we report a rare postoperative complication in which a patient with a double uterine and vagina received RVF following rectal cancer surgery. The patient received radiotherapy and developed rectal anastomotic stenosis leading to scar hyperplasia around the fistula, making repair difficult. Complex RVF is prone to release, which despite the multitude of procedures and treatments reported, optimal strategies remain controversial. Our previous studies showed how the use of rectal mucosal advancement flap (RMAF) with transanal endoscopic surgery (TES) can repair mid-low RVF. We successfully repaired RVF and rectal anastomotic stenosis with staging TES in this complex case. This highlights the safety and utility of TES treatment for complex RVF. Further studies are now required to confirm its effectiveness.
直肠阴道瘘（RVF）是由于直肠和阴道之间出现异常的上皮化连接而形成的。直肠癌手术仍然是RVF的主要病因。在此，我们报告一例罕见的术后并发症，一名双子宫双阴道患者在直肠癌手术后发生了RVF。该患者接受了放疗，出现直肠吻合口狭窄，导致瘘管周围瘢痕增生，使得修复变得困难。复杂性RVF易于复发，尽管已有众多关于手术和治疗方法的报道，但最佳策略仍存在争议。我们之前的研究表明，经肛门内镜手术（TES）联合直肠黏膜推进皮瓣（RMAF）可修复中低位RVF。在这例复杂病例中，我们通过分期TES成功修复了RVF和直肠吻合口狭窄。这突出了TES治疗复杂性RVF的安全性和实用性。目前需要进一步研究以证实其有效性。
