直肠癌全直肠系膜切除术后 直肠阴道瘘原因与防治

THE CAUSE,PREVENTION AND TREATMENT OF RECTOVAGINAL FISTULA FOLLOWING TOTAL MESORECTAL EXCISION(TME)IN RECTAL CANCER(A REPORT OF 18 CASES)

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道瘘的临床资料,发现直肠阴道瘘多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。瘘的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离,以及手术技巧、手术难度、引流方法有关,而与是否进行预防性造口,以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗,即肠内营养,阴道冲洗,早期配合肠外营养、及全身或局部抗炎治疗,大部分直肠阴道瘘通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。

Data of 18 patients with rectovaginal fistula following total mesorectal excision （TME） in rectal cancer in our hospital were retrospectively analysed, It was found that rectovaginal fistula often occurred in patients with middle and low rectal cancer after total mesorectal excision, The eases of rectovaginal fistula were related to tumor site, tumor stage, distenee of tumor to anal, the skill of operation, the degree of operation diffieulty and method of drain. But there were no associations between recto vaginal fistula and the diverting ostomy established at the initial operation or laparoscopic operation. In order to prevent rectovaginal fistula, sharp dissection between rectrum and vagina, the vacunm- assisted closure in pelvis and the coloanal or colorectal anasto- mosis technique should be stressed, In the treatment of rectovaginal fistula, conservative treatments should be first performed, they included enteral nutrition, vaginal washing, and local or systemic anti - inflammatory treatment in the early stage. Most of patients with rectovaginal fistula could be cured, only unrecovering patients should undergo diverting ostomy. If rectovaginal fistula was hard to be healed for a long time after conservative treatments, the local recurrence of rectal cancer should be considered.