The Application And Clinical Analysis Of Removing Petal Of Mucous Membrane Of Rectum Technology In The Low And Mid-level Rectovaginal Fistula

Objective:To explore the application and clinical analysis of removing petal of mucous membrane of rectum technology in the low and mid-level rectovaginal fistulaMethods:The clinical data of 40 cases with rectovaginal fistula from Jan- uary 1998 to March 2008 have been analyzed.Results:The 40 cases were divided into two groups. There were 15 cases in the removing petal of mucous membrane of rectum group to repair rectovaginal fistula,14 cases of success for one time, 1 case of failure caused by eating too early. There was 1 complication of mucosal bleeding. There were 25 cases in conventional surgery group(the neoplasty per perineum, vagina and anal sphincter),15 cases of success for one time,10 cases of failure which succeeded by second operations.There were 6 complications, 1 case of copracrasia which fistula was caused by radiotherapy of terminal stage of gynecologic tumor, 1 case of archosyrinx, 4 cases of infection of perineal region incision. All cases had been followed up in special clinics regularly, or through phone calls and correspondence approach. Follow-up time was 1 month to 3 years. 1case of the removing petal of mucous membrane of rectum group and 10 cases of conventi- onal surgery group were failure in follow-up.Conclusion:Rectovaginal fistula was the pathological channel between the anterior wall of rectum and the posterior vaginal wall and a special lesion that was less common but significant harm, which caused physical or mental harm to a lot of women and impacted their quality of life. In recent years, iatrogenic injury was a gradual increase in the trend. Rectovaginal fistula were generally treated by surgery. The neoplasty per perineum, vagina and anal sphincter were used in the past. There were defects such as a high recurrence rate, lots of complications and severe pain at incisions. The treatment for the low and mid-level rectovaginal fistula by removing petal of rectum has significant advantages such as simplicity of operator, smaller injury , faster recovery, less pain and fewer postoperative complications. the removing petal of mucous membrane of rectum technology and the removing petal of whole range of rectum technology both use mobile valve, but there were significant differences: (1) the removing petal of mucous membrane of rectum technology just libs and moves the mucous membrane of rectum,but the removing petal of whole range of rectum technology libs and moves the mucous membrane, submucosa and part of muscular layer.(2) the removing petal of mucous membrane of rectum surgery is simple and turns complex operations into simple anastomosis of mucosa to mucosa, which has advantages of smaller injury and faster postoperative recovery, but the removing petal of whole range of rectum technology is complex,and has two steps to repair per anum and vaginam,which has disadvantages of larger injury and slower postoperative recovery.(3) the removing petal of mucous membrane of rectum technology reduces the possibility of recurrence by using electric knife to reduce bleeding and avoiding injection of epinephrine saline which can cause necrosis of the mucosa. this removing petal of mucous mem- brane of rectum technology also has differences with other removing petal of mucous membrane of rectum technology: in this group we first explore that rectovaginal fistula is single or multiple , then burn orificium fistulae by electric knife and sew up orificium fistulae by the 0 / 3 absorbable suture , we do not remove orificium fistulae and mucosa under orificium fistulae; others reported that they remove orificium fistulae and mucosa under orificium fistulae to dentate line.(2) in this group we sew up the free moving mucosal flap down to the normal mucosa under orificium fistulae or dentate line; others report that they sew up the free moving mucosal flap to the anal skin.(3) in this group we reduce the possibility of recurrence by using electric knife to reduce bleeding and avoiding injection of epinephrine saline which can cause necrosis of the mucosa and use absorbable suture,others reported that they didn't use electric knife and just use silk suture. The time for surgery is the key to success. The principles are that the injury wounds of rectovaginal interval by the surgical injury or trauma should be immediately repaired; oppressed necrotic fistula and inflammatory fistula should be repaired 4-6 months post-injury after inflammation subsided; If there are huge rectovaginal fistula, serious vagina scar, difficulties to expose or other fistula such as urinary fistula combined with, sigmoid colon stoma should be made first, then neoplasty of fistulous tract should be done about 4weeks later when there were no excretion excreted through vaginal . Urinary fistula should be repaired first if there was. If the fistula really can not be repaired, sigmoid colon can be dragged out and take the place of the rectum of rectal fistula or permanent colostomy should be done directly. The orificium fistulae of congenital vaginal fistula was generally less than 1cm, if it is simple without anal atresia, surgery should be done after menarche, in order to avoid cicatricial narrowing of the vagina by surgery. As a result of the rectum with a large number of germ multiplied, bowel preparation should be done pre-operate and bowel should be cleaned adequately, the rectum and vagina should be disinfected strictly on operation, in order to have a good healing environment of surgical field, which were the keys of the success of the surgery. At the same time, the selections of surgical indications and improved and careful aftertreatments are also very important.