Wu Dongyang,Chen Yajun,Wang Zengmeng,et al.Redo surgery for iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease[J].Journal of Clinical Pediatric Surgery,2022,21(11):1024-1028.[doi:10.3760/cma.j.cn101785-202204093-005]
先天性巨结肠根治术后医源性直肠阴道瘘的再手术治疗
- Title:
- Redo surgery for iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease
- Keywords:
- Megacolon; Hirschsprung’s Disease; Rectovaginal Fistula; Laparoscopes; Surgical Procedures; Operative
- 摘要:
- 目的 分析先天性巨结肠根治术后医源性直肠阴道瘘的发生原因，探讨再次手术治疗的方法及效果。方法 回顾性分析2007年12月至2020年12月首都医科大学附属北京儿童医院普外科收治的6例先天性巨结肠根治术后医源性直肠阴道瘘患儿临床资料。再次手术治疗的方式包括经腹经肛Soave术、经会阴或经肛门修补手术。分析发生直肠阴道瘘的原因，总结手术经验，随访预后情况。结果 6例患儿临床表现均为自阴道内漏出粪便，其中4例出现在初次手术后，2例出现在再次手术后；行再次手术的原因分别为手术后腹腔出血、存在肠无神经节细胞段残留。4例合并吻合口回缩、狭窄，采用经腹经肛Soave术治疗直肠阴道瘘及吻合口回缩、狭窄，均经单次修复获成功；2例仅单纯局部修补直肠阴道瘘，其中1例经肛门修补2次后瘘管闭合，1例经会阴/经肛门局部修补5次后瘘管仍未闭合。结论 先天性巨结肠根治术后直肠阴道瘘是一种较为严重的医源性损伤，在进行先天性巨结肠拖出手术时应紧贴直肠黏膜下层或直肠壁分离，以避免损伤阴道。经腹经肛Soave手术修复直肠阴道瘘成功率高，可同时处理吻合口回缩、狭窄。
- Abstract:
- Objective To explore the causes of iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease (HD) and summarize the experiences and efficacies of reoperation.Methods From December 2007 to December 2020, retrospective review was conducted for clinical data of 6 HD children with iatrogenic rectovaginal fistula after pull-through.The surgical procedures for repairing rectovaginal fistula included transabdominal and transanal Soave, transperineal or transanal surgery.Results A total of six girls were included.Clinical manifestation was vaginal excretion.Injuries occurred in initial surgery (n=4) and during redo pull-through (n=2).The reasons for re-operation were postoperative abdominal hemorrhage and aganglionic segment residue.Rectovaginal fistula with anastomotic retraction and stenosis were successfully repaired by transabdominal and transanal Soave procedure in single time(n=4).The remaining two cases underwent simple local repair of rectovaginal fistula, including fistula closure after anal repair twice (n=1) and failed closure after five local (perineal/anal) repairs (n=1).Conclusion Rectovaginal fistula after pull-through in HD is a serious iatrogenic injury.It should be separated close to rectal submucosa/rectal wall to avoid vaginal injury.Transabdominal and transanal Soave procedure has a high success rate for repairing rectovaginal fistula and managing anastomotic retraction and stenosis.
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备注/Memo
收稿日期:2022-04-25。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com