单侧阴股沟组织瓣修复低位直肠阴道瘘八例及文献复习

Application of a unilateral pudendal thigh flap in the treatment of low rectovaginal fistula:a report of eight cases and literature review

目的探讨阴股沟组织瓣修复低位直肠阴道瘘的临床效果。方法自2018年1月至2019年12月中国医学科学院北京协和医学院整形外科医院妇科整形中心对8例直肠阴道瘘患者行单侧阴股沟组织瓣修复术。选择阴唇后动脉与阴道后壁水平线的交点为组织瓣旋转轴点,根据瘘口到轴点的距离,沿阴唇后动脉的轴线方向设计组织瓣,根据瘘口大小采取阴股沟皮瓣或皮下瓣,于肌膜浅层掀起备用。供区可直接分层关闭,在阴道面剥离瘘口处及其周边,缝合直肠侧瘘口,通过皮下隧道将采取的组织瓣转移覆盖瘘口并缝合固定,最后缝合瘘口的阴道侧黏膜。结果8例患者术后随访6个月至2年,组织瓣均成活良好,未出现复发性瘘,生活质量明显提高,有性生活者未诉不适。结论应用阴股沟组织瓣修复低位直肠阴道瘘,能够取得满意的治疗效果,提高患者生活质量,但其远期疗效仍需大样本量长期随访。

Objective To explore the clinical efficacy of pudendal thigh flap in the treatment of low rectovaginal fistula.Methods From January 2018 to December 2019,8 patients with rectovaginal fistula were repaired by unilateral pudendal thigh flap.The intersection of the horizontal posterior vaginal wall and the posterior labial artery was selected as the axial point of the rotation of the tissue flap.According to the distance from the fistula to the axial point,the flap was designed along the axis of the posterior labial artery.According to the size of the fistula,the pudendal thigh flap was used for backup.The donor area can be closed directly,the fistula and its periphery on the vaginal surface was peel off and the rectal fistula was sutured.The pudendal thigh flap was transferred through the subcutaneous tunnel to cover and suture the fistula,and finally suture the vaginal mucosa of the fistula.Results All patients were followed up for 6 months to2 years,all flaps survived well and no recurrent fistula was found.The quality of life was significantly improved.The patients who had sexual life did not complain of discomfort.Conclusion Application of pudendal thigh flap in the repair of low rectovaginal fistula can obtain satisfactory efficacy and improve the quality of life of patients.However,its final efficacy still needs long-term follow-up with a large sample size.