低位直肠癌全直肠系膜切除术后直肠阴道瘘的诊断和治疗

The Cause,Prevention and Treatment of Rectovaginal Fistula Following Total Mesorectal Excision(TME) in Rectal Cancer

目的：分析低位直肠癌全直肠系膜切除（TME）术后发生直肠阴遭瘘的原因，并探讨直肠阴道瘘的治疗方法。方法：回顾性总结2000年1月-2006年6月共187例女性患者低位直肠癌患者行全直腑系膜切除术后（腹腔镜手术切除23例）后，19例发生直肠阴道瘘的时间、部位、瘘口的直径与肿瘤的分期、大小和位置等关系。结果：直肠阴道瘘的发生率为10．62％（19／187例），其中低位单纯型瘘36．84％（7／19例）。中位单纯型瘘52．6：3％（10／19例）。复杂瘘10．52％（2／19例）。因吻合口瘘局部感染致阴道瘘52．63％（10119例）。因电刀或超声刀妁伤直肠瘘21．05％（4／19例）。4饲患者行肠内、外营养治疗30天内治愈，15例行回肠造瘘术，13例在3个月内瘘口自愈。1倒行经阴道瘘口修补术治愈。结论：直肠阴道瘘（RVF）常见为手术损伤和局部感染等原因有关。痿发生和脑造瘘转流肠内容物是治疗的关键，复杂瘘应行手术修复。

Objective： To investigated the cause and treatment of postoperative rectovaginal fffistulas （RVF） ater total mesorectal excision （TME） for r rectal carcinoma Method： The medical records of 187 female patients with lower rectal carcinoma between 2000/1 - 2006/6 were examined retrospectively with respect to the time, location, and the correlation between diameter o the rectovagginal fistulas （RVF） and the stage, size, situation of the carcinoma.Results： Of the 187 patients, 19 developed RVFclinically, an incidence of 10.62% .Of these, lower simple leakage in 7 （36.84%）, middle simple leakage in 10 （52.63 % ）, complex leakage in 2 （10.52 % ）; 10 cases （52.63 % ） were caused by inection of anastomotic leakage, and 4 cases （21.05 % ） were cased by trauma of electro surgical unit （ESU） or ultrasoic harmonnic scalpel （UHS）; 4 cases were cured by TPN or TEN no more than one month, 15 eases undertaken ileostomy, 13 eases recovered themselves within 3 monthea, 1 case cured by repairment of the rectovaginal fistulas.Conclusion： The most frequent causes of postoperative rectovaginal fistulas （RVF） after total mesorectal excision （TME） is the damadge off operation or the infection of anastomofic leakage.ileostomy is critical for the treatment, but the simple can recover themselves, while the complex should be cheated by operation.