Giebel G D, Karanjia N D
II. Lehrstuhl für Chirurgie, Universität Köln.
Zentralbl Chir. 1993;118(2):84-8; discussion 89.
The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.
导致控尿器官创伤最常见的原因是分娩时的损伤。特别是在疏忽或未进行重建后，除了尿失禁外还可能出现直肠阴道瘘。本报告涉及24例有会阴撕裂伤的尿失禁女性。分娩后，17名女性出现低位直肠阴道瘘。除了对尿失禁进行临床记录外，平均在手术前和术后25个月进行了包括肛门测压在内的直肠检查。所有患者均接受相同的手术：切开前联合，必要时切除瘘管，分别缝合肛门内括约肌和外括约肌，进行阴道成形术。术前静息压力平均为30 cm H₂O，自主压力为46 cm H₂O。术后静息压力增至61 cm H₂O，自主压力增至77 cm H₂O。22例患者报告有改善。发现13名女性完全控尿，7名有粪便污染，2名有排气失禁，1名有液体粪便失禁，1名有大便失禁。随访期间有1例瘘管复发。与其他手术方法相比，我们的手术方法具有相似的效果且避免了保护性结肠造口术的优点。此外，仍然可以选择其他手术方法。
