应用 CO2 阴道激光治疗直肠阴道瘘的临床与影像学联合缓解：病例系列和中期随访。
Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up.
机构信息
Department of Surgery, Faculty of Medicine, Universidade Federal de Juiz de Fora, Rua Doutor Waldyr Lorentz, 11, Juiz de Fora, MG, CEP: 36.037-752, Brazil.
Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
出版信息
BMC Res Notes. 2023 Dec 19;16(1):371. doi: 10.1186/s13104-023-06666-8.
INTRODUCTION
Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment.
OBJECTIVES
A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment.
SUBJECTS AND METHODS
The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ).
RESULTS
The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn's disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI.
CONCLUSION
CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.
简介
尽管手术和临床方法取得了进展，但对于直肠阴道瘘（RVF）的最佳治疗方法仍存在争议。在 RVF 的治疗中，面对具有挑战性的情况，分束二氧化碳激光作为一种可能的治疗方法受到关注。
目的
这是一项单中心、前瞻性、开放标签研究，评估激光治疗 RVF 的有效性和安全性。
受试者和方法
2018 年 8 月至 2022 年 7 月，共有 15 名患者在茹泽乌达福拉大学医院接受了治疗。纳入标准为存在任何病因的临床可疑 RVF，通过盆腔磁共振成像（MRI）和妇科检查得到证实。所有患者在完成治疗后，均接受了 5 次分束 CO2 激光治疗，每月间隔一次，治疗结束后进行全面评估，包括临床检查和盆腔 MRI。治疗前后的性功能分析采用女性性指数（FSQ）进行。
结果
通过体格检查评估，所有患者的阴道均未出现持续的炎症迹象。此外，15 名患者中有 10 名（67.7%）RVF 症状达到临床缓解，33.3%的患者报告症状显著改善。值得注意的是，5 名无既往性行为的患者恢复了正常的性行为，而 7 名基线有性行为的患者的性功能通过 FSQ 评估得到改善。4 名造口患者中有 3 名完成了造口逆转，且无任何不适。所有 6 名因克罗恩病导致 RVF 的患者均报告症状和性功能明显改善。盆腔 MRI 证实 7 名（47%）患者达到放射学缓解。
结论
CO2 分束激光可作为治疗 RVF 的一种有前途且安全的治疗选择。
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