Angioli Roberto, Panici Pierluigi Benedetti, Mirhashemi Ramin, Mendez Luis, Cantuaria Guillherme, Basile Stefano, Penalver Manuel
Department of Obstetrics and Gynecology, Università di Roma Campus Bio-Medico, Via Longoni 69, 00155 Rome, Italy.
Crit Rev Oncol Hematol. 2003 Dec;48(3):281-5. doi: 10.1016/s1040-8428(03)00126-4.
Pelvic exenteration is one of the most destructive gynecologic operations performed on an elective basis, with consequent detrimental effects on the quality of life. The use of reconstructive surgery has significantly improved the quality of life of women undergoing this type of procedure. In this paper we review our experience with continent urinary diversion (Miami Pouch) and low colorectal anastomosis at the Division of Gynecologic Oncology of the University of Miami.
Patients who underwent creation of the continent urinary diversion Miami Pouch from 1988 to 1997 and supralevator pelvic exenteration with low colorectal resection and primary anastomosis from 1990 to 1997 have been included in this study. Management of complications, with particular emphasis on the conservative treatment, has been reviewed in detail for each patient. Open surgery and conservative treatment have been compared. Analysis of complications in irradiated and nonirradiated patients was performed.
77 patients who underwent creation of the Miami Pouch entered this study. Forty patients underwent total pelvic exenteration, and 37 patients underwent posterior exenteration. The most common urinary complications were ureteral stricture/obstruction (22.1%), difficult catheterisation (19.5%) and pyelonephritis (16.9%). Conservative management strategies were successfully used in 80% of the complications. Analysis of breakdown and fistula formation after low colorectal anastomosis was performed on 77 patients. Thirty-five percent of the irradiated patients developed anastomotic breakdown or fistulas, while the occurrence of this type of complications was only 7.5% in the nonirradiated group.
Reconstructive procedures after pelvic exenteration present a significant risk of complications, especially in irradiated patients. Most of the complications related to the creation of continent urinary diversion can safely be treated conservatively. Low colorectal anastomosis carries an acceptable risk of complications in nonirradiated patients, but the risk in irradiated patients is very high, therefore, detailed patient selection and extensive counselling in these groups of patients is mandatory.
盆腔脏器清除术是选择性进行的最具破坏性的妇科手术之一，会对生活质量产生不利影响。重建手术的应用显著改善了接受此类手术女性的生活质量。本文回顾了我们在迈阿密大学妇科肿瘤学部门进行可控性尿流改道术（迈阿密袋）和低位结肠直肠吻合术的经验。
本研究纳入了1988年至1997年接受可控性尿流改道术迈阿密袋创建以及1990年至1997年接受经肛提肌盆腔脏器清除术并低位结肠直肠切除及一期吻合术的患者。对每位患者的并发症处理，尤其着重于保守治疗，进行了详细回顾。比较了开放手术和保守治疗。对接受放疗和未接受放疗的患者的并发症进行了分析。
77例行迈阿密袋创建术的患者纳入本研究。40例患者接受了全盆腔脏器清除术，37例患者接受了后盆腔脏器清除术。最常见的泌尿系统并发症是输尿管狭窄/梗阻（22.1%）、导尿困难（19.5%）和肾盂肾炎（16.9%）。80%的并发症成功采用了保守治疗策略。对77例患者进行了低位结肠直肠吻合术后吻合口漏及瘘形成的分析。35%接受放疗的患者发生吻合口漏或瘘，而未接受放疗组此类并发症的发生率仅为7.5%。
盆腔脏器清除术后的重建手术存在显著的并发症风险，尤其是在接受放疗的患者中。与可控性尿流改道术相关的大多数并发症可通过保守治疗安全处理。低位结肠直肠吻合术在未接受放疗的患者中并发症风险可接受，但在接受放疗的患者中风险非常高，因此，对这些患者群体进行详细的患者选择和广泛的咨询是必要的。
