Sugita Hiroki, Egami Hiroshi, Yokoyama Yoshiki, Suyama Ken-ichi, Ogawa Michio
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Int Surg. 2007 Sep-Oct;92(5):249-53.
The optimal therapy for carcinoma of the rectum with invasion of the prostate gland has not been established. For a patient who has rectal carcinoma invading into the prostate and seminal vesicles and not invading into any other pelvic viscera, we performed combined radical retropubic prostatectomy and abdominoperineal excision of the rectum with reconstruction of the urinary tract by anastomosis of the ureter to the bladder. En bloc excision yielded negative surgical margins. After the operation, the patient had an infection of the abdominal wound and leakage of the anastomosis of the urethra to the bladder. These complications were treated conservatively and improved without becoming critical. The patient now has satisfactory postoperative function of voiding. This technique obviates the need for urinary diversion or urinary reconstruction such as the neobladder in the case of total pelvic exenteration. We consider this procedure is of benefit for improving the quality of life of patients with rectal cancer invading into the prostate.
直肠腺癌侵犯前列腺的最佳治疗方法尚未确定。对于一名直肠癌侵犯前列腺和精囊但未侵犯其他盆腔脏器的患者，我们实施了耻骨后前列腺根治性切除术联合腹会阴直肠切除术，并通过输尿管与膀胱吻合重建尿路。整块切除获得了阴性手术切缘。术后，患者出现腹部伤口感染及尿道与膀胱吻合口漏。这些并发症经保守治疗后好转，未发展至严重程度。患者目前术后排尿功能良好。该技术避免了全盆腔脏器清除术时所需的尿流改道或诸如新膀胱等尿路重建。我们认为该手术方法有助于提高直肠癌侵犯前列腺患者的生活质量。
