带血管筋膜瓣移位修复直肠阴道隔的临床研究

REPAIR OF RECTOVAGINAL SEPTUM WITH PEDICLED FASCIA FLAP

目的探讨采用带血管筋膜瓣移植悬吊盆底与修复直肠阴道隔治疗直肠前突(rectocele,RC)的临床效果。方法2004年8月~2006年8月,收治12例RC患者,采用带血管筋膜瓣移植悬吊盆底与修复直肠阴道隔的方法进行治疗。均为女性,年龄49~73岁。病程5~30年,平均5.6年。主要表现均为排便困难。X线排便造影示:均为重度RC(≥30mm),伴会阴下降(≥40mm)综合征、直肠黏膜内脱垂3例及肛管狭窄9例。切取筋膜瓣范围15cm×3cm^18cm×5cm。术后每2个月定期随访。结果2例患者术中出血约800ml,余约500ml。术后筋膜瓣均成活。11例伤口期愈合,1例由于过早下床活动伤口裂开延迟愈合;供区期愈合。术后4~6d均正常排便。2例供区皮下积液,1例尿潴留合并尿道感染,均经对症治疗后痊愈。11例患者获随访6~12个月。直肠肛门检查直肠前壁凹陷消失,表面光滑平整,指压弹性良好,接近正常直肠前壁。X线及CT排便造影检查示RC凹陷消失。结论带血管筋膜瓣移植悬吊盆底与修复直肠阴道隔可有效恢复直肠阴道隔解剖结构,恢复其功能,是治疗RC的有效方法之一。

Objective To observe the clinical effect of repairing rectovaginal septum with graft of fascia flap with blood vessels. Methods From August 2004 to August 2006, 12 female patients with rectocele were treated,aging 49-73 years. The disease course was from 5 to 30 years（mean, 5.6 years）. All patients suffered dysporia. X-ray films showed severe rectocele （≥30 mm）, or with the descendent perineum syndrome（≥40 mm）, and inner pendant rectal mucosa （3 cases） and/or narrow anal canal （9 cases）. The size of fascia flap ranged from 15 cm × 3 cm to 18 cm × 5 cm. Results The bleeding amount was 800 ml in 2 cases, and 500 ml in 10 cases. All fascia flaps survived. In the 12 patients, 11 had a primary wound healing（Stage 1 ）, 1 had a delayed wound healing（Stage I ）. The donor sites healed at Stage I. Twelve patients could defecate normally 4-6 days after surgery. The legs edema occurred in 2 cases, urinary retention combined with infection occurred in l case. And all recovered completely after treatment. Eleven patients were followed up for 6 to 12 months. Digital anorectal examination showed prerectal pouch disappearance, glaze surface and good elasticity. X-ray films and CT showed that the rectocele disappeared. Conclusion The operation of repairing rectovaginal septum with graft of fascia with blood vessels can effectively recover anatomy of rectovaginal septum and its normal biological function.