股薄肌转移修补复杂直肠阴道(尿道)瘘的前瞻性研究  

Prospective study of gracilis muscle repair of complex rectovaginal fistula and rectourethral fistula

作　　者：陈小兵[1] 廖代祥[1] 罗成华[1] 于军辉[1] 张展志[1] 刘刚[1] 李兵[1] 郝玉娟[1] 刘新志[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院结直肠肛门外科,100038

出　　处：《中华胃肠外科杂志》2013年第1期52-55,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评估股薄肌转移修补治疗复杂直肠阴道（尿道）瘘的临床疗效。方法前瞻性收集2009年5月至2011年11月间在北京世纪坛医院接受股薄肌转移修补治疗的19例复杂直肠阴道（尿道）瘘患者的临床资料。记录修补成功率和手术并发症，并于术前及术后6个月分别进行SF-36生活质量评分、Wexner肛门失禁评分及女性性功能评分。结果19例患者中男性8例（直肠尿道瘘），女性11例（直肠阴道瘘）。术前修补0-3（平均1．0）次，瘘口直径0．5～2．5（平均1．6）cm，均位于肛门括约肌上方。手术时间145。400（中位240）min，术后住院时间10。39（中位21）d。术后近期出现大腿麻木疼痛2例，小腿麻木2例；无远期并发症出现。术后随访6-35（中位18）个月，修补成功率94．7％（18／19）。术后6个月时。19例患者的Wexner评分由术前10．0±8．8降为2．9±5．8，控粪功能显著改善（P=0．002）；11例女性患者的性功能评分由术前的1．0±1．8升高至4．0±4．0。性功能显著改善（P=0．022）；SF-36生活质量评分显著提高（P〈0．001）。结论股薄肌转移修补治疗复杂直肠阴道（尿道）瘘成功率高，并发症少而轻微，疗效确切。Objective To assess the efficacy and experience of gracilis muscle transposition for complex rectovaginal fistula （RVF） and rectourethral fistula （RUF）. Methods Nineteen patients underwent gracilis muscle transposition for complex RVF and RUF from May 2009 to November 2011 in the Beijing Shijitan Hospital and the clinical data were prospectively collected. The success rate and complications were recorded. SF-36 quality of life score, Wexner fecal incontinence score, and female sexual function score before surgery and 6 months after surgery were recorded. Results In 19 patients, there were 8 males （RUF） and 11 females （RUF）. The times of failed attempt repair preoperatively ranged from 0-3 （mean, 1.0）. The diameter of the fistula ranged from 0.5-3.0 cm （mean, 1.6）, and all fistulas located above the sphincter. The operative time ranged from 145-400 minutes （median, 240）. The postoperative hospital stay ranged from 10-39 days （median 21）. Early postoperative complications included thigh pain and numbness in 2 cases, leg numbness in 2 cases. No long-term complications were noticed. The follow-up period ranged from 6-35 months （median, 18）. The gracilis muscle transposition had a healing rate of 94.7% （18/19）. As compared with the preoperative level, Wexner score decreased from 10.0±8.8 to 2.9 ±5.8, and the continence function improved significantly （P=0.002）. Sexual function score of 11 female patients increased from 1.0±1.8 to 4.0±4.0, and the sexual function had a significant improvement after surgery（P=0.022）. SF-36 quality of life scores improved significantly（P〈0.001）. Conclusions Gracilis muscle transposition for complex rectovaginal fistula and rectourethral fistula has high success rate with mild and rare complications.

关 键 词：直肠阴道瘘 直肠尿道瘘 股薄肌 治疗效果 生活质量 

分 类 号：R657.1[医药卫生—外科学]