Lechner P, Cesnik H
Outpatients Department of Surgical Oncology, Landeskrankenhaus, Graz, Austria.
Dis Colon Rectum. 1992 Dec;35(12):1157-60. doi: 10.1007/BF02251968.
Adjuvant radiotherapy (RT) in adenocarcinoma of the rectum requires the application of between 5,500 and 6,600 cGy, while the small bowel does not tolerate doses beyond 4,200 cGy without developing enteritis, often followed by stenosis, fistulas, or perforation. This has spurred several attempts to form an artificial diaphragm between the abdominal cavity and the true pelvis, but they were all burdened with various sequelae. Thus, we developed a simple technique to retain the small bowel out of the RT target volume. From the greater omentum we form a bag, which houses the intestinal loops. The lower margin of the omentum is attached to the parietal peritoneum of the posterior abdominal wall beyond the promontorium. The lateral edges are sutured to the ascending and descending colon. RT starts immediately after the laparotomy wound has healed. With the help of this abdominopelvic omentopexy, we have performed high-dose RT following tumor resection in 43 patients. RT was free of complications in all of them as far as the small bowel is concerned. Proctitis and/or cystitis occurred in 14 patients.
直肠癌的辅助放疗需要应用5500至6600厘戈瑞的剂量，而小肠无法耐受超过4200厘戈瑞的剂量而不发生肠炎，肠炎常继发狭窄、瘘管或穿孔。这促使人们多次尝试在腹腔和真骨盆之间形成人工隔膜，但都伴有各种后遗症。因此，我们开发了一种简单的技术，将小肠移出放疗靶区。我们从大网膜形成一个袋子，用来容纳肠袢。网膜的下缘附着于腹后壁在岬部上方的壁腹膜。侧边缝合于升结肠和降结肠。剖腹手术伤口愈合后立即开始放疗。借助这种腹盆腔网膜固定术，我们对43例患者在肿瘤切除后进行了高剂量放疗。就小肠而言，所有患者放疗均无并发症。14例患者发生了直肠炎和/或膀胱炎。
