肛门正常的直肠前庭瘘病因及治疗方法多中心回顾性分析

Multicenter Retrospective Analysis of Pathogenesis and Treatment of Rectovestibular Fistula with Normal Anus

目的评估肛门正常的直肠前庭瘘(RVFNA)的治疗方法,探讨RVFNA的发病原因。方法回顾性分析2006年1月-2012年1月收治的206例RVFNA患儿的临床资料。年龄3个月～15岁。其中23例患儿曾于外院接受手术治疗失败。181例患儿出生3个月内有明确会阴部感染史,之后在排气或排稀便时前庭部有气体或少量粪便漏出。77例患儿会阴部感染之前曾有腹泻。198例前庭有1个瘘口,8例具有2个瘘口,瘘口之间有皮桥相连。患儿内口均在齿状线以上。173例外口直径<5 mm。本组102例行经肛门直肠前庭瘘修补术,87例行经会阴直肠前庭瘘修补术,17例行会阴成形术,均未出现术后会阴体开裂。结果 29例术后4～10 d前庭瘘复发,其中12例通过每日3次硼酸溶液坐浴治疗自愈,另17例再次手术修补。电话或门诊随访2个月～3 a,患儿排便功能均正常。结论 RVFNA大多是因后天感染获得而不是先天性疾病。采用经肛门或经会阴前庭瘘修补术疗效较为满意。复杂的会阴修补术和肠造瘘术对多数RVFNA患儿是不必要的。

Objective To explore the treatment and discuss the pathogenesis of rectovestibular fistula with normal anus （ RVFNA ）. Methods From Jan. 2006 to Jan. 2012,206 female patients with RVFNA were collected. The patients＇ ages ranged from 3 months to 15 years. Twenty - three children previously had a failed previous operation in other institutions. One hundred and eighty - one patients had a definite history of vulvar inflammation within 3 months after birth and fecal leakage thereafter;in 77 patients, a perineal abscess appeared after an episode of diarrhea. One hundred and ninety - eight patients had 1 external opening,whereas 8 others had 2 external openings separated by a skin bridge. In all the cases,the internal orifice opened above the dentate line. The fistula in 173 cases presented as an opening with a small diameter （ 〈 5 ram）. In the series,vestibular- rectal pull -through procedure was performed in 87 cases, trausanal procedure in 102 cases, and perineoplasty anterior perineal anoreetoplasty in 17 cases. None had a diverting eolostomy. Results Recurrence of fistula occurred in 4 to 10 days after operation in 29 cases,and 12 cases of them healed spontaneously after daily sitz bath with boric acid,whereas the other 17 pa- tients required reoperation. Follow - up was obtained by telephone or by personal visit in the outpatient department, for 2 months up to 3 years. All the patients were continent and had regular bowl movement. Conclusions Most RVFNA is acquired after infection. Procedure requiring ex- tensive perineal dissection and diverting colostomy are unnecessary in most RVFNA cases. The simple resection was performed in most patients with satisfactory results. Procedure requiring extensive perineal dissection and diverting colostomy are unnecessary in most RVFNA cases.