改良York-Mason术式联合同种脱细胞真皮基质修补直肠尿道瘘的疗效分析  

Efficacy analysis of modified York-Mason procedure combined with human acellular dermal matrix for repair of recto-urinary fistula

作　　者：曾彦恺[1] 刘菲[1] 王涛[1] 陈跃东[1] 邢金春[1] ZENG Yankai;LIU Fei;WANG Tao;CHEN Yuedong;XING Jinchun(Department of Urology,First Affiliated Hospital of Xiamen University,Xiamen,Fujian,361000,China)

机构地区：[1]厦门大学附属第一医院泌尿外科,福建厦门361000

出　　处：《临床泌尿外科杂志》2024年第12期1123-1125,共3页Journal of Clinical Urology

基　　金：2020年福建省医学创新课题项目(No:2020CXB046)。

摘　　要：目的:探讨改良York-Mason术式联合同种脱细胞真皮基质修补直肠尿道瘘的疗效。方法:回顾性分析2013年9月—2023年9月厦门大学附属第一医院泌尿外科采用改良York-Mason术式联合同种脱细胞真皮基质修补直肠尿道瘘的8例患者的临床资料。患者平均年龄65.3(56~76)岁,瘘口皆位于直肠低位,平均直径19(6~45) mm;6例瘘口为1个,2例瘘口≥2个。8例修补术前均行膀胱造瘘及结肠造口术。修补手术采用俯卧折刀体位,经肛门括约肌切除直肠尿道瘘口,分离尿道、直肠壁后行瘘口修补术,修补过程中使用同种脱细胞真皮基质。术后予留置尿管、抗感染处理,保留膀胱造瘘管。术后3个月复查尿道膀胱镜,修补成功者拔除膀胱造瘘管。以排尿时肛门无漏液,同时影像学检查未发现瘘口为修补成功标准。结果:8例共行10次修补术,手术时间平均90(55~125) min。第1次修补术后中位随访时间22(6~30)个月。修补成功7例(87.5%),其中6例1次修补成功,重复修补2例(重复修补均为经肛门括约肌路径,其中2次手术修补成功1例;2次手术修补失败1例,因患者术前曾接受盆腔外放射治疗,修补失败后尿道膀胱镜检查见瘘口大、周围组织僵硬,遂行双侧输尿管皮肤造口,患者最终尿粪改道生存)。结论:采用改良York-Mason术式联合同种脱细胞真皮基质修补直肠尿道瘘创伤小、并发症少,可重复手术;其疗效确切,成功率高,较适合于低位、未经放疗的患者。Objective:To investigate the efficacy of modified York-Mason procedure combined with human acellular dermal matrix for repair of recto-urinary fistula.Methods:The clinical data of 8patients in the Department of Urology of the First Affiliated Hospital of Xiamen University from September 2013to September 2023 were analysed.The mean age was 65.3(56-76)years old,and the fistula sites were at the low rectum,with a mean diameter of 19(6-45)mm.All 8patients underwent cystostomy and colostomy before repair.The repair surgery was performed in the prone folding knife position.The recto-urinary fistula was removed through the anus,and the urethra and the rectal wall were separated for fistula repair.Human acellular dermal matrix was used during the repair process.After surgery,the retention catheterization and anti-infection treatment were performed,and the cystostomy tube was retained.Urethral cystoscopy was reviewed 3months after the operation,and the cystostomy tube was removed in the successful patients.The standard for successful repair was no anal leakage during urination or fistula found by the imaging examination.Results:Eight patients underwent 10repairs,and the average operation time was 90(55-125)min.The median follow-up was 22(6to 30)months after the first repair.Seven cases(87.5%)were repaired successfully including 6cases of once repair and 1case of twice repairs.Two cases of repeated repairs were all through transanal route.Only 1case failed,because the patient had received preoperative external pelvic radiotherapy.Larger fistula and stiff surrounding tissues were found by urethral cystoscopy.Then,the bilateral ureteral skin stomas were performed,and the patient finally underwent urinary and fecal diversions.Conclusion:Modified York-Mason procedure combined with human acellular dermal matrix can repair recto-urinary fistula with less trauma and complications and be applied repeatedly.Its definite efficacy and high success rate are suitable for fistula patients with low site and without radiotherapy.

关 键 词：直肠尿道瘘 改良York-Mason术式 同种脱细胞真皮基质 粪失禁 

分 类 号：R699[医药卫生—泌尿科学]