Houvenaeghel G, Moutardier V, Karsenty G, Bladou F, Lelong B, Buttarelli M, Delpero J R
Department of Surgery, Institut Paoli-Calmettes, 13009 Marseille, France.
Gynecol Oncol. 2004 Feb;92(2):680-3. doi: 10.1016/j.ygyno.2003.11.003.
The objective of this study was to analyze the postoperative outcome of patients undergoing urinary diversion at the time of pelvic exenteration.
Between January 1980 and December 2002, 232 pelvic exenterations for gynecologic malignancies were performed in our hospital. One hundred and twenty-four included a urinary diversion. There were locally advanced or recurrent cancers including 101 cervical, 11 endometrial, 5 vagina, 2 ovarian malignancies and 5 pelvic sarcoma.
Ninety patients (72.5%) had a history of previous irradiation. Exenterations were 69 anterior and 55 total. Urinary diversion included 14 bilateral ureterostomies, 62 trans-intestinal diversion and 48 continent diversion using distal ileum and right colon. Pelvic filling was performed in 56 patients (45%). Low colorectal anastomosis was performed in 42 of 48 supralevator pelvic exenteration (87.5%). Postoperative mortality rate was 8% (10/124). Overall 12-week postoperative morbidity rate was 52% (65/124) and appears to be significantly higher in irradiated patients and after total exenteration. In trans-intestinal noncontinent group, eight patients were reoperated for a complication directly related to urinary diversion procedure. No reoperation for such a complication was performed in the continent urinary diversion group.
Ileocolic continent pouch seems to be the safer urinary diversion procedure after exenteration for gynecological malignancies especially in irradiated patients and after total exenteration.
本研究的目的是分析盆腔脏器清除术时行尿流改道患者的术后结局。
1980年1月至2002年12月期间，我院对232例妇科恶性肿瘤患者实施了盆腔脏器清除术。其中124例进行了尿流改道。这些患者均为局部晚期或复发性癌症，包括101例宫颈癌、11例子宫内膜癌、5例阴道癌、2例卵巢恶性肿瘤和5例盆腔肉瘤。
90例患者（72.5%）有既往放疗史。盆腔脏器清除术包括69例前盆腔脏器清除术和55例全盆腔脏器清除术。尿流改道方式包括14例双侧输尿管造口术、62例经肠道改道和48例利用回肠末端和右半结肠的可控性改道。56例患者（45%）进行了盆腔填充。48例高位盆腔脏器清除术中42例（87.5%）进行了低位结直肠吻合术。术后死亡率为8%（10/124）。术后12周总体发病率为52%（65/124），在接受放疗的患者和全盆腔脏器清除术后发病率似乎明显更高。在经肠道非可控性改道组，8例患者因与尿流改道手术直接相关的并发症接受了再次手术。可控性尿流改道组未因此类并发症进行再次手术。
对于妇科恶性肿瘤患者，尤其是接受放疗的患者和全盆腔脏器清除术后，回结肠可控性尿袋似乎是更安全的尿流改道手术方式。
