关键词: 直肠阴道瘘, 干细胞治疗, 克罗恩病, 放射性损伤, 磁共振成像, 肛门括约肌功能, 组织瓣移植术

Abstract: A rectovaginal fistula (RVF) refers to an abnormal pathological tract between the rectum and vagina, allowing the passage of gas, mucus, or fecal material into the vaginal cavity. RVF accounts for 1%-5% of anorectal fistulas, with common etiologies including obstetric trauma, iatrogenic surgical injury, inflammatory bowel disease (Crohn’s disease), malignancy, and radiation-induced tissue damage. RVF not only disrupts physiological functions but may also lead to sexual dysfunction and diminished quality of life. Diagnosis relies on comprehensive evaluation of medical history, clinical manifestations, imaging modalities (colonoscopy, digital rectal examination, ultrasonography, and MRI), and endoscopic assessment. Therapeutic strategies vary depending on etiology, fistula classification, and patient health status. Surgical intervention remains the primary treatment. However, individualized approaches are necessary due to the complexity of causative factors and fistula anatomy. Common surgical techniques include advancement flap repair, transperineal proctetomy, tissue flap transplantation, and endoscopic procedures. Conservative management may be effective for small and asymptomatic fistulas. For radiation-induced RVF, treatment requires careful consideration of radiation-induced tissue impairment, with a balanced assessment of survival prognosis and quality of life. Advances in medical technology, including minimally invasive surgery and stem cell therapy, offer promising therapeutic alternatives. Further improvements in diagnostic and therapeutic approaches for RVF are anticipated with ongoing basic research and clinical experience accumulation, ultimately enhancing patient outcomes.

Key words: rectovaginal fistula, stem cell therapy, Crohn’s disease, radiation-induced injury, magnetic resonance imaging, anal sphincter function, tissue flap transplantation