Groom J S, Nicholls R J, Hawley P R, Phillips R K
Department of Surgery, St Mark's Hospital, London, UK.
Br J Surg. 1993 Jul;80(7):936-40. doi: 10.1002/bjs.1800800750.
Between January 1976 and June 1991, 161 women underwent restorative proctocolectomy. Seventeen (10.6 per cent) developed pouch-vaginal fistula. There was no difference in the incidence of inflammatory (15 of 141; 10.6 per cent) and non-inflammatory (two of 20; 10 per cent) disease, the severity of colitis or the number of stages in the operation. In 15 patients the fistula involved the ileoanal anastomosis; in two it had possibly occurred at the dentate line. There was no significant difference in the proportion of hand-sewn (ten of 120; 8.3 per cent) and stapled (seven of 41; 17 per cent) ileoanal anastomosis. Of the 17 women, six had pelvic sepsis in the immediate postoperative period and five had an anastomotic complication. There was no case of Crohn's disease. Three patients developed a pouch-vaginal fistula before closure of the ileostomy. The remaining 14 fistulas occurred a median of 7 (range 1-144) months after closure. Five further patients were referred from elsewhere to give a total of 22 for analysis of treatment and outcome. The fistula developed before ileostomy closure in five patients (group 1) and after closure in 17 (group 2). Following treatment, six fistulas had healed with five patients still undergoing treatment. In group 1, three of the five fistulas healed, whereas in group 2 only three of the 17 healed. Eight patients required excision of the pouch. The prognosis appears to be worse when pouch-vaginal fistula occurs after ileostomy closure. The optimal management is not yet established.
1976年1月至1991年6月期间，161名女性接受了直肠结肠修复切除术。其中17例（10.6%）发生了贮袋阴道瘘。炎性疾病（141例中的15例；10.6%）和非炎性疾病（20例中的2例；10%）的发病率、结肠炎的严重程度或手术分期数量均无差异。15例患者的瘘累及回肠肛管吻合口；2例可能发生在齿状线处。手工缝合的回肠肛管吻合口（120例中的10例；8.3%）和吻合器吻合的回肠肛管吻合口（41例中的7例；17%）比例无显著差异。17名女性中，6例在术后近期发生盆腔感染，5例出现吻合口并发症。无克罗恩病病例。3例患者在回肠造口关闭前发生了贮袋阴道瘘。其余14例瘘发生在关闭回肠造口后的中位时间为7个月（范围1 - 144个月）。另外5例患者从其他地方转诊而来，共计22例用于治疗和结局分析。5例患者（第1组）的瘘在回肠造口关闭前出现，17例（第2组）在关闭后出现。经过治疗，6例瘘已愈合，5例仍在接受治疗。在第1组中，5例瘘中有3例愈合，而在第2组中，17例中只有3例愈合。8例患者需要切除贮袋。回肠造口关闭后发生贮袋阴道瘘时，预后似乎更差。最佳治疗方法尚未确定。
