基于放疗相关直肠阴道瘘临床特征的手术治疗分析  

Surgical management based on clinical features of radiotherapy-related rectovaginal fistula

作　　者：林承志 黄军杰 朱勇武 王瑜 张再重 LIN Chengzhi;HUANG Junjie;ZHU Yongwu;WANG Yu;ZHANG Zaizhong(Department of General Surgery,900th Hospital of Joint Logistics Support Force,Fuzhou 350025,China;College of Integrative Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China)

机构地区：[1]联勤保障部队第九○○医院普通外科,福建福州350025 [2]福建中医药大学中西医结合学院,福建福州350122

出　　处：《中国肿瘤外科杂志》2023年第2期180-183,共4页Chinese Journal of Surgical Oncology

基　　金：福建省自然科学基金(2022J01489);福建省科技厅引导性项目(2021Y0061);福建医科大学启航基金(2021QH1322);联勤保障部队第九○○医院科研计划基金(2021MS24)。

摘　　要：目的基于放疗相关直肠阴道瘘(RI-RVF)的临床特点探讨手术治疗方法,以期为临床诊治提供参考。方法回顾性分析联勤保障部队第九○○医院2012年1月至2022年8月间收治的34例直肠阴道瘘患者的临床资料,其中RI-RVF组20例、非RI-RVF组14例,对两组患者的年龄、病程、瘘口、手术情况及术后情况等进行分析总结。结果10年期间收治的RI-RVF患者占比58.82%。两组相比RI-RVF患者年龄更大[(56.35±11.16)岁vs.(31.71±16.93)岁,t=5.123,P<0.001],瘘口直径更大[(3.18±0.64)cm vs.(1.74±0.77)cm,t=5.922,P<0.001],手术时间更长[110(91.25,120.00)min vs.85(60.00,98.75)min,Z=2.607,P=0.009],而术后住院天数较少[5.0(4.25,7.00)d vs.10.5(9.75,13.25)d,Z=-4.931,P<0.001]。RI-RVF组中16例行单纯肠造瘘,2例行预防性肠造瘘+直肠切除,1例行预防性肠造瘘+瘘修补,1例行单纯瘘修补;非RI-RVF组中6例行单纯肠造瘘,2例行预防性肠造瘘+瘘修补,6例行单纯瘘修补。两组的手术方式比较差异有统计学意义(P<0.05);在病程及术中出血量这两方面比较差异均无统计学意义(P>0.05);除1例RI-RVF术后20 d复发、4例RI-RVF因肿瘤复发导致愈后不良及1例非RI-RVF因术后瘘反复再发外,其余患者均恢复良好。结论RI-RVF具有炎症浸润、血管硬化及肠壁纤维化等特点,康复更加困难,需综合考虑放疗后局部条件及肿瘤进展情况等因素,选择个体化治疗方式。Objective To investigate surgical treatment of radiotherapy-related rectovaginal fistula(RI-RVF),in order to provide reference for clinical diagnosis and treatment.Methods The clinical data of 34 cases with rectovaginal fistula admitted to the 900th Hospital of Joint Logistics Support Force between January 2012 and August 2022 were retrospectively analyzed and divided into the RI-RVF group(20 cases)and the non-RI-RVF group(14 cases).And the age,disease duration,fistula,surgical condition and postoperative condition of the two groups were compared.Results The patients with RI-RVF took up 58.82%of the population admitted during the 10-year period.The patients with RI-RVF were older([56.35±11.16]years vs.[31.71±16.93]years,t=5.123,P<0.001),who had longer diameter of fistula([3.18±0.64]cm vs.[1.74±0.77]cm,t=5.922,P<0.001),longer operative time(110[91.25,120]min vs.85[60,98.75]min,Z=2.607,P=0.009),and fewer postoperative hospital days(5[4.25,7]d vs.10.5[9.75,13.25]d,Z=-4.931,P<0.001).There was significant difference on operation between the two groups).There was not significant difference on the duration of the disease and intraoperative bleeding(P>0.05).All patients recovered well except for one case of RI-RVF with recurrence 20 d after surgery,four cases of RI-RVF had poor prognosis due to tumor recurrence and one case of non-RI-RVF with recurrent recurrence of fistula due to post-rectal surgery.Conclusions RI-RVF is characterized by inflammatory infiltration,vascular sclerosis and intestinal wall fibrosis,which makes recovery more difficult.Individualized treatment modalities need to be selected by taking into account local conditions and tumor progression after radiotherapy.

关 键 词：放疗 直肠阴道瘘 肠造瘘 临床特征 手术治疗 

分 类 号：R730.55[医药卫生—肿瘤]