Cuttat J F, Coucke P, Mirimanoff R
Service de chirurgie, CHUV, Lausanne.
Schweiz Med Wochenschr. 1991 Jul 20;121(29):1055-61.
The combination of radiotherapy and surgery plays a major role in treating pelvic cancer. However, this technique is chiefly limited by the radiosensitivity of the small bowel following postoperative radiotherapy. In this situation the small bowel is not protected because of its lack of mobility. A radioprotective prosthesis is presented which is readily removable and whose purpose is to push the small bowel out of the pelvis during radiotherapy, thus protecting it from radiotherapy. If required, a simple system allows the prosthesis to be emptied and refilled between courses of radiotherapy, if required, without reoperation. This technique has been used in 4 patients: 2 had rectal carcinoma secondary to ulcerative colitis in one case and to Crohn's disease in the other; the other 2 cases were recurrent rectal carcinoma, one of which was partially resectable. When radiotherapy was completed the prosthesis could be deflated and removed through a short incision under local anesthetic. In the medium term, no small bowel complications were observed in spite of high-dose radiotherapy. When used for radiosensitive pelvic tumors, this technique combines low cost and ease of use with very low morbidity and the possibility of administering high-dose radiotherapy.
放疗与手术相结合在盆腔癌治疗中发挥着重要作用。然而，该技术主要受术后放疗时小肠放射敏感性的限制。在这种情况下，由于小肠缺乏可移动性，无法得到保护。现介绍一种放射防护假体，它易于取出，其目的是在放疗期间将小肠推出盆腔，从而使其免受放疗影响。如有需要，一个简单的系统可让假体在放疗疗程之间排空并重新填充，无需再次手术。该技术已应用于4例患者：2例为溃疡性结肠炎继发直肠癌，另1例为克罗恩病继发直肠癌；另外2例为复发性直肠癌，其中1例可部分切除。放疗完成后，可在局部麻醉下通过一个小切口将假体放气并取出。从中期来看，尽管进行了高剂量放疗，但未观察到小肠并发症。当用于对放疗敏感的盆腔肿瘤时，该技术成本低、使用方便，发病率极低，且有可能进行高剂量放疗。
