经阴道瘘管翻转结扎修补术治疗62例中低位直肠阴道瘘的临床疗效观察

Transvaginal fistula flip and ligation for mid-and low rectovaginal fistula:an analysis of 62 cases

目的探讨经阴道瘘管翻转结扎修补术治疗中低位直肠阴道瘘的临床疗效。方法回顾性分析2010年1月至2020年6月于我科接受经阴道瘘管翻转结扎修补术的62例中低位直肠阴道瘘患者的临床资料,记录手术相关指标及术后随访情况。结果62例患者中,中位手术时间为60(30,90)min,中位术后首次排粪时间为3(2,4)d,中位术后留置导尿管时间为5(3,6)d,中位住院时间为16.0(14.0,21.3)d,8例有保护性造口的患者为直肠癌术后造口尚未还纳。术后随访有14例脱落,中位随访时间为48.0(12.8,87.0)个月。在48例按既定计划实施随访的患者中,31例治愈、17例未愈,均无严重术后并发症。未愈患者中,2例于术后1年行经阴道瘘管吻合器闭合术治疗后未见阴道排气排粪;15例未进行再次手术修补,仅有轻微阴道排气症状。结论经阴道瘘管翻转结扎修补术治疗中低位直肠阴道瘘的总体手术疗效较为理想,操作相对简单,安全性良好。

Objectives To investigate the clinical efficacy of transvaginal fistula flip and ligation for mid-and low rectovaginal fistula.Methods This was a retrospective analysis of 62 patients with mid-and low rectovaginal fistula treated with transvaginal fistula flip and ligation at our department between January 2010 and June 2020.Surgical details and postoperative follow-up were collected.Results Of the 62 patients,the median duration of surgery was 60(30,90)minutes;median time to the first postoperative bowel movement was 3(2,4)days;median postoperative catheters duration was 5(3,6)days;median duration of hospitalization was 16.0(14.0,21.3)days.Eight patients with prophylactic stoma did not undergo stoma reversal following rectal cancer surgery,and the stoma is protective.The median duration of postoperative follow-up was 48.0(12.8,87.0)months.Fourteen patients were lost to follow-up.Among the 48 patients who completed the follow-up,31 were considered cured,and 17 were considered not cured,with no severe postoperative complications.Among patients considered not cured,two underwent transvaginal stapler closure of fistula at one year postoperative and experienced no vaginal flatulence and defecation;the remaining 15 patients did not undergo subsequent repairment surgery and experienced mild symptoms of vaginal flatulence.Conclusion Transvaginal fistula flip and ligation show satisfactory overall efficacy for mid-and low rectovaginal fistula.It is a relatively simple and safe procedure.