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직장질루의 치료

Repair of Rectovaginal Fistulas

대한대장항문학회지 1999년 15권 1호 p.65 ~ 71
박원갑 ( Park Won-Kap ) - 송도병원 외과

황도연 ( Hwang Do-Yeon ) - 송도병원 외과
김건욱 ( Kim Khun-Uk ) - 송도병원 외과
이광렬 ( Lee Kwang-Ryul ) - 송도병원 외과
유정준 ( Yoo Jung-Jun ) - 송도병원 외과
임석원 ( Lim Seok-Won ) - 송도병원 외과
김현식 ( Kim Hyun-Sik ) - 송도병원 외과
이종균 ( Lee Jong-Kyun ) - 송도병원 외과

Abstract


Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25∼56) years. The mean follow-up after operation was 33 (range, 8∼62) months. The etiology of the fistula in the majority of patients was
obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap
advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient’s history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should
be performed.

키워드

Rectovaginal fistula;Mucosal advancement flap;Rectovaginal septum;Sphincteroplasty;Perineal body reconstruction
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