直肠阴道瘘经阴道手术治疗探讨

摘要

Objective-To-explore-the-feasibility-of-transvaginal-approach-vaginoplasty-for-rectovaginal-fistula-(-RVF-)-.-Methods-A-total-of-13-patients-with-RVF-were-given-transvaginal-approach-vaginoplasty-from-February-2007-to-April-2013.Among-the-patients,-there-were-4-cases-of-secondary-repair-and-3-cases-having-two-orifices-.The-operation-was-performed-6-months-after-fistula-formation-in-all-the-cases-.Without-resection-of-fistula-,-the-wound-was-repaired-with-the-surrounding-tissues-after-centripetal-separation-.-Results-All-the-13-cases-were-successfully-operated-.No-colostomy-was-required-.The-operation-time-was-25-55-min-(-mean,-35-±15-min).All-the-cases-were-followed-up-for-0.5--7-years-(mean,-2.5-years)-without-recurrence.-Conclusions-Transvaginal-rectovaginal-fistula-repair-is-safe,-effective-and-simple.Removal-of-fistula-is-unnecessary.The-preoperative-preparation,-selection-of-operative-methods,-and-postoperative-management-are-the-key-to-a-successful-treatment-.%目的：探讨直肠阴道瘘（ rectovaginal fistula ，RVF）经阴道手术修补的方法及手术成功的关键。方法2007年2月～2013年4月，对13例RVF经阴道修补。其中4例为RVF二次修补术，3例有2个瘘孔。均于瘘口形成半年后手术，术中不切除瘘管，采用“向心性”分离，充分利用瘘口周围的组织填补加固创面。结果13例瘘口均顺利愈合，无须行结肠造瘘术。手术时间25～55 min，（35±15）min。随访0．5～7年，平均2．5年，无复发。结论直肠阴道瘘经阴道修补简单易行，术中无需切除瘘管，手术时机、术前准备、术式的选择、术后管理是直肠阴道瘘治疗成功的关键。