直肠阴道瘘诊治进展  

Advances in the diagnosis and treatment of rectovaginal fistula

作　　者：唐景彤 周建平[1] TANG Jing-tong;ZHOU Jian-ping(Department of Gastrointestinal Surgery/Hernia Surgery,the First Affiliated Hospital of China Medical University,Shenyang Clinical Medical Research Center for Medical Nutrition,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院胃肠外科/疝外科,沈阳市医学营养临床医学研究中心,辽宁沈阳110001

出　　处：《中国实用外科杂志》2025年第3期351-355,共5页Chinese Journal of Practical Surgery

基　　金：辽宁省科技计划联合计划项目(技术攻关计划项目)(No.2024JH2/102600301);沈阳市科学技术计划公共卫生研发专项项目(No.22-321-33-03)。

摘　　要：直肠阴道瘘是指直肠和阴道之间出现病理性通道,可导致直肠中的气体、黏液和粪便通过瘘管进入阴道。其发生率占肛门直肠瘘的1%~5%,常见病因包括产科创伤、手术损伤、炎症性肠病(如克罗恩病)、肿瘤、放射性损伤等。直肠阴道瘘的发生不仅会影响病人的生理功能,还可能导致性功能障碍和生活质量下降。其诊断依赖病史、临床表现、影像学检查及内镜检查等多种手段,常用的检查方法包括结肠镜、肛门指诊、超声、MRI等。直肠阴道瘘的治疗方式多样,依据病因、瘘管分类以及病人健康状况不同,选择不同的治疗手段。手术治疗是主要的治疗方式,但由于病因和瘘管的复杂性,手术方式需个体化选择。常见手术方法包括推移瓣修补术、经会阴直肠切开术、组织瓣移植术及内镜手术。对于一些小而无症状的瘘管,保守治疗可能有效。放射性直肠阴道瘘的治疗则需要考虑辐射损伤带来的影响,治疗时应综合评估病人的生存期和生活质量。随着医疗技术的发展,微创手术和干细胞治疗等新兴疗法为病人带来了希望。未来,随着基础研究的深入和临床经验的积累,直肠阴道瘘的诊治方法有望进一步改善,病人的生活质量也将得到提升。A rectovaginal fistula(RVF)refers to an abnormal pathological tract between the rectum and vagina,allowing the passage of gas,mucus,or fecal material into the vaginal cavity.RVF accounts for 1%-5%of anorectal fistulas,with common etiologies including obstetric trauma,iatrogenic surgical injury,inflammatory bowel disease(Crohn’s disease),malignancy,and radiation-induced tissue damage.RVF not only disrupts physiological functions but may also lead to sexual dysfunction and diminished quality of life.Diagnosis relies on comprehensive evaluation of medical history,clinical manifestations,imaging modalities(colonoscopy,digital rectal examination,ultrasonography,and MRI),and endoscopic assessment.Therapeutic strategies vary depending on etiology,fistula classification,and patient health status.Surgical intervention remains the primary treatment.However,individualized approaches are necessary due to the complexity of causative factors and fistula anatomy.Common surgical techniques include advancement flap repair,transperineal proctetomy,tissue flap transplantation,and endoscopic procedures.Conservative management may be effective for small and asymptomatic fistulas.For radiation-induced RVF,treatment requires careful consideration of radiation-induced tissue impairment,with a balanced assessment of survival prognosis and quality of life.Advances in medical technology,including minimally invasive surgery and stem cell therapy,offer promising therapeutic alternatives.Further improvements in diagnostic and therapeutic approaches for RVF are anticipated with ongoing basic research and clinical experience accumulation,ultimately enhancing patient outcomes.

关 键 词：直肠阴道瘘 干细胞治疗 克罗恩病 放射性损伤 磁共振成像 肛门括约肌功能 组织瓣移植术 

分 类 号：R6[医药卫生—外科学]