Nakafusa Yuji, Matsushita Shigeto, Shimonishi Tomonori, Uemura Tetsushi, Tomiyama Yusuke, Miyazaki Kohji
Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
Hepatogastroenterology. 2007 Sep;54(78):1679-81.
Perineal wound failure associated with infection is one of the intractable complications after abdominoperineal resection including pelvic exenteration. It is supposed that there is a strong possibility of this complication occurring in patients with infected perineal lesions after radiation therapy. We describe herein a case of a 56-year-old female who received pelvic exenteration for recurrent rectal cancer, the perineal wound of whom was successfully managed by a two-step operation using muscle flaps. The patient had a recurrent tumor in her pelvis after abdominoperineal resection for locally advanced rectal cancer. She had been treated with chemoradiotherapy for the recurrent tumor. The tumor was exposed to the perineum and was associated with bacterial infection. The tumor was curatively resected by total pelvic exenteration. The perineal wound infection was controlled by a lay-open method after reconstruction of the pelvic floor using a rectus abdominis muscle. The perineal wound was secondarily closed using gracilis mycocutaneous flaps 14 days after pelvic exenteration. She was discharged uneventfully 14 days after perineal closure. The strategy in the present report may be a useful option for perineal wound management in patients with a high risk of perineal wound failure due to infection after abdominoperineal resection.
会阴伤口感染相关的愈合不良是包括盆腔脏器清除术在内的腹会阴联合切除术后难以处理的并发症之一。据推测，放疗后会阴病变感染的患者发生这种并发症的可能性很大。我们在此描述一例56岁女性，因复发性直肠癌接受盆腔脏器清除术，其会阴伤口通过使用肌皮瓣的两步手术成功处理。该患者因局部晚期直肠癌行腹会阴联合切除术后盆腔出现复发性肿瘤。她接受了针对复发性肿瘤的放化疗。肿瘤暴露于会阴并伴有细菌感染。通过全盆腔脏器清除术将肿瘤根治性切除。使用腹直肌重建盆底后，通过敞开引流法控制会阴伤口感染。盆腔脏器清除术后14天，使用股薄肌肌皮瓣二期缝合会阴伤口。会阴伤口缝合14天后，她顺利出院。本报告中的策略可能是腹会阴联合切除术后因感染导致会阴伤口愈合不良风险较高的患者会阴伤口处理的有用选择。
