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本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道瘘的临床资料,发现直肠阴道瘘多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。瘘的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离,以及手术技巧、手术难度、引流方法有关,而与是否进行预防性造口,以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗,即肠内营养,阴道冲洗,早期配合肠外营养、及全身或局部抗炎治疗,大部分直肠阴道瘘通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。
In this paper, we analyzed the clinical data of 18 patients with rectovaginal fistula after total mesorectal excision in our hospital in the recent 5 years and found that patients with rectovaginal fistula mostly occurred in low and medium rectal cancer undergoing total mesorectal excision. The occurrence of fistula and the location of the tumor, tumor staging, the distance from the anus and the tumor, as well as surgical techniques, surgical difficulty, drainage methods, and whether the preventive ostomy, and whether the use of laparoscopic surgery has nothing to do. Prevention should emphasize the importance of intraoperative rectal wall acute separation, colorectal anastomosis and postoperative pelvic negative pressure drainage. Treatment should be the first conservative treatment, namely, enteral nutrition, vaginal irrigation, early with parenteral nutrition, and systemic or local anti-inflammatory treatment, most of the rectovaginal fistula can be cured by conservative treatment. Conservative treatment is invalid when considering the distal colon or ileostomy. If long-term unhealthy should consider the possibility of anastomotic tumor recurrence.