Dasmahapatra K S, Swaminathan A P
Comprehensive Surgical Associates, Perth Amboy, NJ.
Arch Surg. 1991 Mar;126(3):366-9. doi: 10.1001/archsurg.1991.01410270114018.
Radiation-associated small bowel injury occurs in up to 50% of patients receiving postoperative radiotherapy following pelvic cancer surgery. We describe our experience using a biodegradable mesh that allows the small bowel to be supported above the pelvic inlet and is totally absorbed following radiation therapy. Between 1985 and 1989, 45 procedures were performed in patients with carcinoma of the rectum (anterior resection in 15 patients, abdominoperineal resection in 23 patients, pelvic exenteration in six patients, and proctocolectomy in one patient). In 30 patients a polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin 910 (Vicryl) mesh was used. Forty-four patients received postoperative radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no immediate complications related to the mesh. Follow-up ranged from 12 to 53 months (median follow-up, 34 months). With the exception of two patients who had a polyglactin 910 mesh and who developed bowel obstruction due to adhesions under the anterior abdominal wall, there has been no documented incidence of clinical radiation-associated small bowel injury. The use of the absorbable mesh may permit us to use higher doses of postoperative radiotherapy without the associated hazard of radiation-associated small bowel injury.
接受盆腔癌手术后放疗的患者中，高达50%会发生放射性小肠损伤。我们描述了使用一种可生物降解网片的经验，该网片可使小肠支撑于盆腔入口上方，且放疗后会完全吸收。1985年至1989年期间，对45例直肠癌患者实施了手术（15例行前切除术，23例行腹会阴联合切除术，6例行盆腔脏器清除术，1例行直肠结肠切除术）。30例患者使用了聚乙醇酸（德克松）网片，15例患者使用了聚乳酸910（薇乔）网片。44例患者接受了术后放疗。平均（±标准误）剂量为56.8±18.4 Gy。未出现与网片相关的即刻并发症。随访时间为12至53个月（中位随访时间为34个月）。除2例使用聚乳酸910网片的患者因前腹壁下粘连导致肠梗阻外，未记录到临床放射性小肠损伤的发生情况。使用可吸收网片可能使我们能够使用更高剂量的术后放疗，而不会有放射性小肠损伤的相关风险。
