PDF(Pubmed)
Abstract：
BACKGROUND: Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment.
OBJECTIVE: A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment.
METHODS: The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ).
RESULTS: The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn\'s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI.
CONCLUSIONS: CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.
OBJECTIVE: A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment.
METHODS: The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ).
RESULTS: The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn\'s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI.
CONCLUSIONS: CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.
摘要：
背景：尽管手术和临床方法取得了进展，对于直肠阴道瘘(RVF)的最佳治疗方案尚无共识.面对RVF方法中具有挑战性的情况，分数CO2激光作为一种可能的治疗形式受到关注。
目标：单中心，prospective,开放标签研究评估激光治疗RVF的有效性和安全性。
方法：2018年8月至2022年7月在JuizdeFora大学医院招募了15名患者。纳入标准是存在通过盆腔磁共振图像（MRI）和妇科检查证实的任何病因的临床可疑RVF。完成治疗后，对所有患者进行了五次分次CO2激光治疗，每月间隔一次，然后通过临床检查和盆腔MRI进行完整评估。使用女性性商（FSQ）对治疗前后的性功能进行分析。
结果：通过体格检查进行的评估显示，所有患者的阴道均无持续性炎症体征。此外,15例患者中有10例(67.7%)实现了RVF症状的临床缓解，而33.3%的患者报告有显著改善。值得注意的是，根据FSQ评估,5例以前没有过性行为的患者恢复了规律的性活动,而7例有基线性活动的患者的性功能有所改善.四分之三的造口术患者的造口术逆转，并且没有抱怨。所有6名继发于克罗恩病的RVF患者均报告症状和性功能明显改善。骨盆MRI证实了7例（47％）患者的放射学缓解。
结论：CO2点阵激光可被认为是治疗RVF的一种有希望且安全的替代治疗方法。
目标：单中心，prospective,开放标签研究评估激光治疗RVF的有效性和安全性。
方法：2018年8月至2022年7月在JuizdeFora大学医院招募了15名患者。纳入标准是存在通过盆腔磁共振图像（MRI）和妇科检查证实的任何病因的临床可疑RVF。完成治疗后，对所有患者进行了五次分次CO2激光治疗，每月间隔一次，然后通过临床检查和盆腔MRI进行完整评估。使用女性性商（FSQ）对治疗前后的性功能进行分析。
结果：通过体格检查进行的评估显示，所有患者的阴道均无持续性炎症体征。此外,15例患者中有10例(67.7%)实现了RVF症状的临床缓解，而33.3%的患者报告有显著改善。值得注意的是，根据FSQ评估,5例以前没有过性行为的患者恢复了规律的性活动,而7例有基线性活动的患者的性功能有所改善.四分之三的造口术患者的造口术逆转，并且没有抱怨。所有6名继发于克罗恩病的RVF患者均报告症状和性功能明显改善。骨盆MRI证实了7例（47％）患者的放射学缓解。
结论：CO2点阵激光可被认为是治疗RVF的一种有希望且安全的替代治疗方法。
