O'Kelly T J, Merrett M, Mortensen N J, Dehn T C, Kettlewell M
Department of Surgery, John Radcliffe Hospital, Oxford, UK.
Br J Surg. 1994 Sep;81(9):1374-5. doi: 10.1002/bjs.1800810943.
Pouch-vaginal fistula is a rare complication following restorative proctocolectomy. Seven patients who developed such a fistula are presented. Six pouch-vaginal fistulas occurred at the level of the pouch-anal anastomosis and one 3 cm above the anastomosis, level with the posterior vaginal fornix. The anastomosis had been hand-sewn in four patients (following mucosectomy) and stapled in three. Five fistulas presented within the perioperative period (median 16 (range 10-30) days) and two at 186 and 273 days. Treatment was successful in the patients who presented early, and these remain continent with functioning pouches. If not already present (two patients), an ileostomy was raised. Repair was by endovaginal flap advancement, combined with fistulotomy and sphincter repair in two patients. Treatment was unsuccessful in the two patients who presented late; in both the diagnosis was revised to Crohn's disease, necessitating pouch excision.
贮袋-阴道瘘是全直肠系膜切除术后一种罕见的并发症。本文报告了7例发生这种瘘的患者。6例贮袋-阴道瘘发生在贮袋-肛管吻合口水平，1例在吻合口上方3 cm，与阴道后穹窿平齐。4例患者（在黏膜切除术后）的吻合口采用手工缝合，3例采用吻合器缝合。5例瘘发生在围手术期（中位时间16天（范围10 - 30天）），2例分别在186天和273天出现。早期出现的患者治疗成功，这些患者仍能保持节制并有功能正常的贮袋。如果尚未进行（2例患者），则行回肠造口术。2例患者通过经阴道皮瓣推进修复，联合瘘管切开术和括约肌修复。2例晚期出现的患者治疗失败；两者均被重新诊断为克罗恩病，需要切除贮袋。
