Turchinets A I, Khmelnitskaya A V, Sulavko Ya P, Ionov A L, Nikolaev V V, Karachentsova I V
Pirogov Russian National Research Medical University, Moscow, Russia.
Russian Children's Clinical Hospital, Moscow, Russia.
Khirurgiia (Mosk). 2021(4):39-45. doi: 10.17116/hirurgia202104139.
To evaluate the long-term results of surgical correction of H-type fistula in girls with a normal anus.
There were 7 patients with rectovestibular fistula and 3 patients with rectovaginal fistula with a normal anus were observed from 2014 to 2019 in the Surgical Department No. 1 of the Russian Children's Clinical Hospital. Upon admission, all patients underwent genital examination, vaginoscopy, rectal examination and probing the fistulous canal, irrigography, abdominal and retroperitoneal ultrasound. They were also examined by a gynecologist and genital smears were obtained. Surgical treatment was determined depending on the height and diameter of the fistula for each child. One patient underwent perineal fistulectomy, three patients - anterior anorectoplasty. Invaginated fistula extirpation, abdominoperineal proctoplasty and perineal fistulectomy using a pad flap between the defects were used in two cases, respectively. Patients were followed-up for the period from 6 months to 1 year after the last recurrence. Follow-up examination, irrigography and functional examination of sphincter were performed.
Two (20%) patients did not require redo surgery. In 6 (60%) cases, recurrences didn't occur within a year after the second surgery, in 2 (20%) cases - after 3 operations. Recurrent H-type fistula appeared after 3 of 4 perineal fistulectomy procedures, 3 of 9 anterior anorectoplasty, 2 of 2 abdominoperineal proctoplasty and 2 of 3 invaginated fistula extirpation. Hypotension of internal anal sphincter and neo-rectal ampulla, recurrent vulvovaginitis were diagnosed in 2 patients in 6 months after anterior anorectoplasty.
We recommend anterior anorectoplasty and perineal fistulectomy using a pad flap between the defects for the treatment of H-type fistula to minimize the risk of recurrence.
评估对肛门正常女童H型瘘管进行手术矫正的长期效果。
2014年至2019年期间，俄罗斯儿童临床医院第一外科观察了7例直肠前庭瘘和3例肛门正常的直肠阴道瘘患者。入院时，所有患者均接受了生殖器检查、阴道镜检查、直肠检查、瘘管探查、灌肠造影、腹部和腹膜后超声检查。他们还接受了妇科医生的检查并采集了生殖器涂片。根据每个孩子瘘管的高度和直径确定手术治疗方案。1例患者接受了会阴瘘管切除术，3例患者接受了前路肛门直肠成形术。分别有2例患者采用了套入式瘘管切除术、腹会阴直肠成形术以及在缺损之间使用垫瓣的会阴瘘管切除术。患者在最后一次复发后随访6个月至一年。进行了随访检查、灌肠造影和括约肌功能检查。
2例（20%）患者无需再次手术。6例（60%）患者在第二次手术后一年内未复发，2例（20%）患者在第三次手术后未复发。4例会阴瘘管切除术中3例、9例前路肛门直肠成形术中3例、2例腹会阴直肠成形术中2例以及3例套入式瘘管切除术中2例出现复发性H型瘘管。2例患者在前路肛门直肠成形术后6个月被诊断为肛门内括约肌和新直肠壶腹功能减退、复发性外阴阴道炎。
我们建议采用前路肛门直肠成形术以及在缺损之间使用垫瓣的会阴瘘管切除术来治疗H型瘘管，以尽量降低复发风险。
