精囊腺肠瘘的探讨

Investigation of Intestinoseminal Vesicle Fistula

目的总结精囊腺肠瘘的病因、临床表现和诊治方法。方法查阅国内外关于精囊腺肠瘘的临床报道的文献,对其病因、临床表现及诊治方法进行分析。结果共查阅到19例精囊腺肠瘘的相关临床报道。精囊腺肠瘘多发生于直肠低位前切除术后伴发吻合口漏、乙状结肠憩室、炎性肠病、前列腺切除或放疗后。症状主要表现为气尿、粪尿、发热、阴囊肿胀疼痛、睾丸炎、附睾炎等。多经增强CT或CT加直肠对比等影像学方法确诊。经留置尿管、抗生素应用、肠外营养等保守治疗和窦道切开引流、黏膜或骨骼肌瓣修补、尿或粪便转流等手术方法多可治愈。结论精囊腺肠瘘是一种少见且独立的疾病,通过对精囊腺肠瘘的分析,以提高对其的认识,避免误诊、误治。

Objective To summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula. Method Literatures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed. Results The clinical reports of 19 patients with intestinoseminal vesicle fistula were searched. The intestinoseminal vesicle fistula occurred af- ter the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy. The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on. Imaging methods such as enhanced CT or CT with rectal.contrast and so on could confirm the diagnosis. The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases. Conclusions The intestinoseminal vesicle fistula is a rare and independent disease. Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreat- ment of the intestinoseminal vesicle fistula.