结直肠肛门外科 (Feb 2025)
Clinical effectiveness analysis of laparoscopic surgical techniques in the treatment of 14 patients with radiation-induced intestinal fistula
Abstract
[Objectives] To investigate the clinical effectiveness of laparoscopic surgical techniques in the treatment of patients with radiation-induced intestinal fistula. [Methods] The clinical data of 14 patients with radiation-induced intestinal fistula who underwent laparoscopic surgical techniques at the Center for Difficult and Complicated Abdominal Surgery, Tenth People’s Hospital of Tongji University from January 2020 to December 2024 were retrospectively analyzed. The basic information about the patients, surgical-related conditions, and postoperative follow-up conditions (follow-up through telephone or outpatient visits) were recorded. [Results] Among the 14 patients, the primary tumor diagnoses included 8 cases of cervical cancer, 2 cases of prostate cancer, and 4 cases of rectal cancer; the intestinal fistula diagnoses included 7 cases of recto-vaginal fistula, 2 cases of vesico-rectal fistula, 1 case of vesico-sigmoid fistula, 1 case of recto-vaginal fistula combined with vesico-rectal fistula, 1 case of rectal fistula, 1 case of small intestine-vaginal fistula, and 1 case of small intestine-presacral fistula; the number of previous surgeries ranged from 2 to 4. In this radiation-induced intestinal fistula surgery: all patients underwent laparoscopic exploration, among whom 6 patients underwent totally laparoscopic surgery, and 8 patients were converted to open surgery after laparoscopic exploration and partial adhesion lysis to complete other surgical procedures; the operative time ranged from 2 to 7 hours; the hospital stay ranged from 5 to 34 days. One patient underwent emergency surgery due to severe intra-abdominal infection and died of disseminated intravascular coagulation on the 10th day after surgery; one patient had an anastomotic leakage 1 month after surgery, underwent ileostomy, and had the ileostomy reversed 6 months later; the remaining 12 patients had good postoperative recovery and showed good food intake and defecation during the 3-month postoperative follow-up. [Conclusion] Based on emphasizing the perioperative management of patients with radiation-induced intestinal fistula, optimizing the methods of preoperative localization and Trocar layout strategy, and with the implementation by an experienced surgical team, the overall safety and feasibility of laparoscopic surgical techniques for radiation-induced intestinal fistula are good.
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