| 特集名 | 直腸・肛門の良性病変 | |
|---|---|---|
| 題名 | 各種治療に続発する病態 (1) 直腸膣瘻 | |
| 発刊年月 | 2000年 07月 | |
| 著者 | 堀 明洋 | 久美愛病院外科 |
| 【 要旨 】 | 直腸膣瘻は各種疾患に続発して発生する．おもな疾患は出産に伴うもの，術後性，骨盤内臓器の悪性腫瘍，放射線治療後，Crohn病である．直腸膣瘻は難治性で自然治癒の傾向はなく，保存的治療に抵抗する．直腸膣瘻の原因疾患の治療がなされている折，瘻孔周囲の炎症，感染が軽快しているときに手術が可能となる．直腸膣瘻の手術の原則は，瘻孔を完全に切除すること，瘻孔切除後の再建では再建組織に緊張がかからないように十分剥離し，直腸と膣の問に健全な組織を置くことである．また，括約筋の断裂が認められる症例では，括約筋機能を改善きせる処置を加えることが重要である． | |
| Theme | Benign Lesions of Rectum and Anus | |
|---|---|---|
| Title | Rectovaginal Fistula | |
| Author | Akihiro Hori | Kumiai Hospital |
| [ Summary ] | Rectovaginal fistulas are abnormal communications between the rectum and vagina. The cause of rectovaginal fistulas are obstetric trauma, inflammatory bowel disease, radiation proctitis, and rectal operations, especially stapled anterior resections. The management of rectovaginal fistulas depends on size, location, cause, anal sphincter function, and health status of the patient. Successful treatment entails excision of the fistula and the interposition of healthy tissue between the rectum and vagina. Surrounding tissue should not be inflamed. Sphincter dysfunctions should also be repaired. The management of simple rectovaginal fistulas, such as those which are low, or small, and secondary to obstetric trauma, may be repaired locally. The endorectal advancement flap or transvaginal layered repair are the methods of choice. When sphincter function is diminished, the external sphincter should be reconstructed. For complex fistulas, such those which are high or large, and recurrent, sphincteroplasty and tissue transposition methods, such as graciloplasty are needed. For disease speciphic fistulas, therapy is determined by the cause of the rectovaginal fistula. In the cases of radiation induced rectovaginal fistulas, the diseased rectum and the sigmoid colon must be resected, and coloanal anastomosis is a satisfactory option. |
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