直肠阴道瘘的诊断治疗现状

Current situation in the diagnosis and treatment of rectovaginal fistula

直肠阴道瘘的临床治疗困难，往往存在复发率高和肛门功能损害的问题。本文通过复习相关文献，结合自身临床实践，针对目前直肠阴道瘘诊疗过程中存在的一些问题进行评述。包括如何对直肠阴道瘘进行全面术前评估，如何选择合适的手术时机，如何根据各种术式的优劣进行合理的选择以及围手术期的规范管理等。细致的专科体检是明确诊断的基础，磁共振和直肠彩超可以协助我们对直肠阴道瘘和周围组织的情况进行精确的标准化评估。适宜的手术时机和良好的肠道准备是手术成功的前提。虽然目前治疗直肠阴道瘘的手术入路和方法很多，但并没有一种针对各种直肠阴道瘘的最佳手术方式，仍需根据瘘及周围组织解剖特点、肛门括约肌的完整性以及既往手术修补史进行个体化选择。围手术期的管理对于提高手术成功率、降低复发率同样至关重要。

The treatment of rectovaginal fistula is quite difficult. It is a formidable challenge for anorectal surgeons to successfully perform operations for rectovaginal fistulas, since both recurrence rate and incontinence rate are high. This commentary elucidates certain questions during the treatment course of rectovaginal fistula through reviewing relevant literature and our clinical practice, including the overall evaluation of the preoperative rectovaginal fistula, the choice of suitable operation timing, reasonable choice of operational procedure and standard perioperative management. Precise special examination is the base of diagnosis. Magnetic resonance and rectal Doppler ultrasound can be helpful to make a precise and standard diagnosis of rectovaginal fistula. Suitable operation timing and satisfactory intestinal preparation are the premise of successful operation. Despite the variety of the surgical treatment, there is still no standard surgical technique with respect to rectovaginal fistula. Individualization must be considered based on the anatomic features of rectovaginal fistula, its surrounding tissues, the integrity of anal sphincter, and operative repair before. Perioperative management is important both in the increase of successful operation rate and the decrease of recurrence rate.