Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only.
Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only.
复制标题
放射性直肠阴道瘘的恢复性切除术比单纯结肠造口术能更好地缓解肛肠症状
DOI：
10.1186/s12957-017-1100-0
复制
发表时间：
2017-02-02
影响因子：
3.2
通讯作者：
Wang L
中科院分区：
文献类型：
--
作者：
Zhong Q;Yuan Z;Ma T;Wang H;Qin Q;Chu L;Wang J;Wang L
背景放射性直肠阴道瘘(RVF)是盆腔恶性肿瘤放疗后的一种严重而疑难的并发症。本研究旨在回顾比较仅在肛门直肠症状缓解的情况下，修复性切除和结肠造口术的结果。方法我们纳入了26例连续的盆腔放疗后出现RVF的病例。我们采用了两种主要的手术方式：一种是修复性切除加结肠肛管拉力吻合术并预防性造口，另一种是不切除的单纯造口术。因此，我们将这些患者分为这两组。记录手术前和术后多个时间点的肛门直肠症状，包括直肠疼痛、出血、内翻、会阴粘膜分泌物，并进行评分。与基线相比，所有患者在术后6个月、12个月和24个月时都获得了良好的疗效，症状有所改善。此外，切除术组的下垂症状(6个月33.3个月比0%；12个月66.7个月比16.7%)和会阴粘膜分泌物(6个月88.9个月比6.7%；12个月77.8个月比15.4%；24个月85.7个月比25.0%)有更好的缓解。而单纯造口组无一例吻合口关闭。结论修复性切除和造口均只能改善放射性肛门直肠瘘的肛门直肠症状，但修复性切除可完全缓解部分病例的肛门直肠症状。
BackgroundRadiation-induced rectovaginal fistula (RVF) is a severe and difficult complication after pelvic malignancy radiation. This study was to retrospectively compare the outcomes of restorative resection and colostomy only in remission of anorectal symptoms.MethodsWe enrolled a cohort of 26 consecutive cases who developed RVF after pelvic radiation. Two main procedures for these patients in our institution were used: one was restorative resection and pull-through coloanal anastomosis with a prophylactic colostomy, and another was a simple colostomy without resection. Thus, we divided these patients into these two groups. Anorectal symptoms including rectal pain, bleeding, tenesmus, and perineal mucous discharge were recorded and scored prior to surgery and at postoperative multiple time points.ResultsThe baseline was similar among the two groups. All patients acquired good efficacy with improved symptoms at postoperative 6, 12, and 24 months, when compared to baseline. In addition, the resection group showed a better remission of tenesmus (6 months 33.3 vs 0%; 12 months 66.7 vs 16.7%) and perineal mucous discharge (6 months 88.9 vs 6.7%; 12 months 77.8 vs 15.4%; 24 months 85.7 vs 25.0%). Furthermore, three (30%) patients in the resection group successfully reversed stomas while no stoma was closed in the simple colostomy group.ConclusionsBoth restorative resection procedure and colostomy only can improve anorectal symptoms of radiation-induced RVF, but restorative resection can completely relieve anorectal symptoms in selected cases.