Schwenk W, Böhm B, Gründel K, Müller J
Department of General Surgery, Humboldt-University, Charité, Schumannstr. 20/21, 10117 Berlin, Germany.
Surg Endosc. 1997 Feb;11(2):147-9. doi: 10.1007/s004649900318.
A 46-year-old Caucasian female underwent vaginal hysterectomy for myoma in another hospital and developed a high rectovaginal fistula 6 weeks later. A diverting-loop colostomy of the sigmoid colon was performed 2 months later. The patient was admitted to our service with persistent high rectovaginal fistula 6 months later. We resected the sigmoid colon and two-thirds of the rectum including the fistula tract using laparoscopic techniques. An intracorporeal anastomosis was accomplished using a double-stapling technique. An omental flap was mobilized and placed between the colorectal anastomosis and the vagina. Except for a subcutaneous wound infection at the former colostomy site, the postoperative course was uneventful. The patient was discharged at the 7th postoperative day and remained free of symptoms. We conclude that laparoscopic resection of high rectovaginal fistula with primary intracorporeal anastomosis is feasible and should be considered in selected cases as an alternative "minimal-invasive" approach to this disease.
一名46岁的白种女性在另一家医院因子宫肌瘤接受了阴道子宫切除术，6周后出现高位直肠阴道瘘。2个月后进行了乙状结肠转流性造口术。6个月后，患者因持续性高位直肠阴道瘘入住我院。我们采用腹腔镜技术切除了乙状结肠和包括瘘管在内的三分之二直肠。使用双吻合器技术完成了体内吻合。游离大网膜瓣并将其置于结直肠吻合口与阴道之间。除了原造口部位的皮下伤口感染外，术后过程顺利。患者术后第7天出院，无症状。我们得出结论，腹腔镜切除高位直肠阴道瘘并进行一期体内吻合是可行的，在某些病例中应考虑将其作为这种疾病的一种替代性“微创”方法。
