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目的:分析低位直肠癌全直肠系膜切除(TME)术后发生直肠阴道瘘的原因,并探讨直肠阴道瘘的治疗方法。方法:回顾性总结2000年1月~2006年6月共187例女性患者低位直肠癌患者行全直肠系膜切除术后(腹腔镜手术切除23例)后,19例发生直肠阴道瘘的时间、部位、瘘口的直径与肿瘤的分期、大小和位置等关系。结果:直肠阴道瘘的发生率为10.62%(19/187例),其中低位单纯型瘘36.84%(7/19例),中位单纯型瘘52.63%(10/19例),复杂瘘10.52%(2/19例)。因吻合口瘘局部感染致阴道瘘52.63%(10/19例)。因电刀或超声刀灼伤直肠瘘21.05%(4/19例)。4例患者行肠内、外营养治疗30天内治愈,15例行回肠造瘘术,13例在3个月内瘘口自愈,1例行经阴道瘘口修补术治愈。结论:直肠阴道瘘(RVF)常见为手术损伤和局部感染等原因有关。瘘发生和肠造瘘转流肠内容物是治疗的关键,复杂瘘应行手术修复。
Objective: To analyze the causes of rectovaginal fistula after total mesorectal excision (TME) of low rectal cancer and to explore the treatment of rectovaginal fistula. Methods: A total of 187 female patients with rectal cancer underwent total mesorectal excision (23 cases after laparoscopic surgery) from January 2000 to June 2006 were retrospectively reviewed. The time and location of rectal vaginal fistula , Fistula diameter and tumor stage, size and location of the relationship. Results: The incidence of rectovaginal fistula was 10.62% (19/187 cases), including 36.84% (7/19 cases) of simple simple fistula, 52.63% (10/19 cases) of simple simple fistula, 10.52% (2/19 cases). Vaginal fistula was caused by local infection of anastomotic fistula (52.63%) (10/19 cases). 21.05% (4/19 cases) of rectal fistula burns due to electric knife or ultrasonic knife burn. Four patients underwent enteral and external nutritional therapy within 30 days. Fifteen patients underwent ileostomy. Thirteen patients recovered from fistula within three months and one patient underwent vaginal fistula repair. Conclusion: Rectovaginal fistula (RVF) is commonly associated with surgical injury and local infection. Fistula occurred and intestinal fistula transfer of intestinal contents is the key to treatment, complicated fistula should be surgically repaired.