Vannelli Alberto, Battaglia Luigi, Poiasina Elia, Leo Ermanno
Division of General Surgery B Foundation IRCCS "National Institute of Tumour", Lymphology La Statale University, Milan, Via Venezian 1, 20133 Milan, Italy.
Med Hypotheses. 2009 Mar;72(3):267-70. doi: 10.1016/j.mehy.2008.10.019. Epub 2008 Dec 10.
Pelvis is a functional shell-like unit consisting of the pelvic floor and perineum. The patients, who underwent a radical operation of the pelvis due to an oncological disease, often develop pelvic disorders. These disorders do not depend on the type of surgery or any presence of postoperative treatment (radio- and chemotherapy). The reason for this is still mostly unknown. These disorders without an appropriate treatment of rehabilitation always result in the following symptoms: fatty tissue hypertrophy and fibrosis as well as functional chronic disorders. Lymphedema is described as a progressive pathological condition with retention of protein-rich liquid in the interstitial space, fatty tissue hypertrophy and fibrosis. It is possible to assume that lymphadenectomy related to pelvic surgery results in a localized lymphedema in the pelvis developing disorders of perineum and pelvic floor: a pelvic lymphedema, or rather a blind lymphedema, i.e. with symptoms but with no signs. The clinical evidence shows that the lymphatic vessels play a relevant role in the pathology of the pelvic floor and perineum. The study of pelvic lymphedema could be the key when choosing the therapies for pelvic disorders resulting from surgery.
骨盆是一个由盆底和会阴组成的功能性壳状单元。因肿瘤疾病接受骨盆根治性手术的患者，常出现骨盆功能障碍。这些功能障碍与手术类型或术后任何治疗（放疗和化疗）的存在无关。其原因大多仍不明确。这些功能障碍若未得到适当的康复治疗，总会导致以下症状：脂肪组织肥大和纤维化以及功能性慢性疾病。淋巴水肿被描述为一种渐进性病理状态，伴有富含蛋白质的液体在间质间隙潴留、脂肪组织肥大和纤维化。可以推测，与骨盆手术相关的淋巴结清扫术会导致骨盆局部淋巴水肿，进而引发会阴和盆底功能障碍：骨盆淋巴水肿，或者更确切地说是隐匿性淋巴水肿，即有症状但无体征。临床证据表明，淋巴管在盆底和会阴的病理过程中发挥着相关作用。骨盆淋巴水肿的研究可能是选择手术所致骨盆功能障碍治疗方法的关键。
