Evaluation of the Innovative Application of Fecal Diversion Devices in Patients with Advanced Tumor-Related Complex Enterovaginal Fistulas

TIAN Yaru; KANG Chunbo

doi:10.13919/j.issn.2095-6274.ZHJY202410036

Abstract：Objective To investigate the therapeutic efficacy and safety of a fecal diversion device in pa-tients with complex enterovaginal fistulas resulting from advanced tumors.Methods A total of 60 patients with advanced tumor-related complex enterovaginal fistulas were included from the Gastrointestinal Rehabilitation Center of Beijing Rehabilitation Hospital affiliated with Capital Medical University,from October 2022 to August 2024.Patients were randomly divided into a control group and a study group,with 30 patients in each group,using a digital randomization method.The control group received standard treatment including fluid replacement,infec-tion control,nutritional support,routine nursing care,and symptomatic treatment.The study group received the same treatment as the control group,supplemented by an innovative transvaginal fecal diversion device.After four weeks of treatment,various parameters were compared between the two groups,including nutritional status(daily food intake,body mass index,serum albumin),inflam-matory and infection markers(white blood cell count,procalcitonin,C-reactive protein,incidence of bacter-emia),cholestasis indicators(direct bilirubin,alkaline phosphatase,gamma-glutamyl transferase),coagulation function(prothrombin time),incidence of incontinence-associated dermatitis and pain(area of incontinence-asso-ciated dermatitis,skin condition score,healing rate of incontinence-associated dermatitis,numerical pain rating in the perineal area),and psychological status(Hamilton Anxiety and Depression Rating Scales).Results There were no statistically significant differences in baseline characteristics between the two groups(P＞0.05).After four weeks of treatment,no deaths occurred in either group.All patients in the study group tolerated the transvaginal fecal diversion device well,with no occurrences of compressive ischemia,necrosis,perforation,or hemorrhagic complications in the vaginal tissue.The study group exhibited significantly better nutritional status,inflammatory and infection markers,cholestasis indicators,and coagulation function compared to the control group(P＜0.05).Ad-ditionally,the area of incontinence-associated dermatitis in the study group was reduced,and the healing rate was higher than that of the control group,with a statistically significant difference(P＜0.05).The numerical pain rating score for the perineal area and the scores on the Hamilton Anxiety and Depression Rating Scales were significantly lower in the study group compared to the control group(P＜0.05).Conclusion The transvaginal use of a fecal diversion device with advanced tumor-related complex enterovaginal fistulas is a safe and effective non-surgical approach.This method significantly improves clinical parameters,promotes the healing of incontinence-associated dermatitis,alleviates perineal pain,reduces psychological stress,and enhances the quality of life for patients.