Aggressive Surgical Treatment Is Justified towards Colovesical Fistulae of Benign Diseases and Post-Radiation Injury: A 10-Year Retrospective Review in 60 Patients

積極外科手術治療對良性疾患與放射傷害造成的大腸膀胱廔管是值得推薦的：十年間60案例的追蹤分析

張皓程(Hao-Cheng Chang) ； 陳進勛(Jinn-Shiun Chen) ； 唐瑞平(Rei-Ping Tang) ； 張簡俊榮(Chung-Rong Changchien) ； 王正儀(Jeng-Yi Wang) ； 江支銘(Jy-Ming Chiang) ； 游耀東(Yau-Tong You) ； 葉建裕(Chien-Yuh Yeh) ； 謝寶秀(Pao-Shiu Hsieh) ； 蔡文司(Wen-Sy Tsai) ； 洪欣園(Hsin-Yuan Hung) ； 游正府(Jeng-Fu You)

《中華民國大腸直腸外科醫學會雜誌》 23卷3期 (2012/09) Pp. 114-121

https://doi.org/10.6312/SCRSTW.2012.23(3).10027

摘要

Background. Colovesical fistula (CVF) is a rare complication of inflammation, located between colon and urinary bladder. Surgical intervention of CVF remained controversial. Patients and Methods. Over a 10-year period, consecutive 60 patients with CVF underwent surgical intervention in Chang-Gung Memorial Hospital. Their demographic data, clinical features, final diagnoses, treatment and surgical outcomes were analyzed. Results. The study recruited 28 males and 32 females, with a mean age of 60.5 years. Of them, 87% had urologic symptoms (fecaluria 68% and pneumoturia 40%), while intestinal symptoms were evident in only 15% of patients. The major causes of the disease included diverticular disease (n=18, 30%), malignancy invasion (n=16, 27%) and post-radiation injury (n=14, 23%). Resection with and without anastomosis was performed in 22 and 9 patients, respectively. Diversion was introduced in 27 patients, while local repair was done in 2 patients. During an averaged 66-month follow-up, survival of patients of post-radiation injury and benign etiologies was significantly different from that of malignancy invasion subgroup (p＜0.001); on the contrary, the survival difference was insignificant between subgroups of benign etiologies and radiation injury (p=0.302). The mean survival period of benign disease and radiation injury group were 89.0 and 69.6 months, respectively. The 7-year survival rates of the two groups were 59.3% and 53.6%, respectively. The surgical/hospital mortality rates in these two groups were lower (6.7% and 7.1 %) than that of malignancy invasion (25%). Conclusion. This study showed the limited surgical mortality rate and long-term disease free survival in CVF patients with benign disease and post-radiation injury, so aggressive surgical intervention was recommended.

關鍵字

大腸膀胱 ； 腸膀胱廔管 ； 憩室炎 ； 外科手術 ； 追蹤研究

並列摘要

Background. Colovesical fistula (CVF) is a rare complication of inflammation, located between colon and urinary bladder. Surgical intervention of CVF remained controversial. Patients and Methods. Over a 10-year period, consecutive 60 patients with CVF underwent surgical intervention in Chang-Gung Memorial Hospital. Their demographic data, clinical features, final diagnoses, treatment and surgical outcomes were analyzed. Results. The study recruited 28 males and 32 females, with a mean age of 60.5 years. Of them, 87% had urologic symptoms (fecaluria 68% and pneumoturia 40%), while intestinal symptoms were evident in only 15% of patients. The major causes of the disease included diverticular disease (n=18, 30%), malignancy invasion (n=16, 27%) and post-radiation injury (n=14, 23%). Resection with and without anastomosis was performed in 22 and 9 patients, respectively. Diversion was introduced in 27 patients, while local repair was done in 2 patients. During an averaged 66-month follow-up, survival of patients of post-radiation injury and benign etiologies was significantly different from that of malignancy invasion subgroup (p＜0.001); on the contrary, the survival difference was insignificant between subgroups of benign etiologies and radiation injury (p=0.302). The mean survival period of benign disease and radiation injury group were 89.0 and 69.6 months, respectively. The 7-year survival rates of the two groups were 59.3% and 53.6%, respectively. The surgical/hospital mortality rates in these two groups were lower (6.7% and 7.1 %) than that of malignancy invasion (25%). Conclusion. This study showed the limited surgical mortality rate and long-term disease free survival in CVF patients with benign disease and post-radiation injury, so aggressive surgical intervention was recommended.

並列關鍵字

Colovesical ； Enterovesical ； Fistula ； Diverticulitis ； Surgical intervention ； Follow-up study