Cresti Silvia, Ouaïssi Mehdi, Sielezneff Igor, Chaix Jean-Baptiste, Pirro Nicolas, Berthet Bruno, Consentino Bernard, Sastre Bernard
Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialités Médicales et Chirurgicales, Hôpital De Timone, Marseille, France.
World J Surg Oncol. 2008 Dec 23;6:136. doi: 10.1186/1477-7819-6-136.
Primary closure of the perineum with drainage after abdominoperineal excision of the rectum for carcinoma, is widely accepted. However hematoma, perineal abscess and re-operation are significantly more frequent after primary closure than after packing of the perineal cavity. Those complications are frequently related to the patients' clinical antecedent (i.e radiotherapy, diabetes, smoking).
In the present report, vacuum assisted drainage was used after abdominoperineal excision for carcinoma in the very first step due to intraoperative gross septic contamination during tumor resection. The first case: A 57-years old man with a 30-years history of peri-anal Crohn's disease, the adenocarcinoma of the lowest part of the rectum and Crohn colitis with multiple area of severe dysplasia required panproctocolectomy with a perineal resection. The VAC system was used during 12 days (changed every 3 days). We observed complete healing 18 days after surgery. The second case: A 51-year-old man, with AIDS. An abdominoperineal resection was performed for recurrence epidermoid anal cancer. The patient was discharged at day 25 and complete healing was achieved 30 days later after surgery.
The satisfactory results showed in the present report appear to be favored by association of omentoplasty and VAC system. Those findings led us to favor VAC system in the case of pelvic exenteration associated with high risk of infection.
直肠癌经腹会阴联合切除术后会阴一期缝合并引流已被广泛接受。然而，与会阴腔填塞相比，一期缝合后血肿、会阴脓肿及再次手术的发生率明显更高。这些并发症常与患者的临床病史有关（如放疗、糖尿病、吸烟）。
在本报告中，由于肿瘤切除术中存在严重的术中感染污染，在第一例经腹会阴联合切除术后即采用了负压封闭引流。第一例：一名57岁男性，有30年肛周克罗恩病病史，直肠最下部腺癌合并克罗恩结肠炎伴多处重度发育异常，需行全直肠结肠切除术与会阴切除术。负压封闭引流系统使用了12天（每3天更换一次）。术后18天观察到完全愈合。第二例：一名51岁男性，患有艾滋病。因复发性表皮样肛管癌行腹会阴联合切除术。患者于术后第25天出院，术后30天实现完全愈合。
本报告中显示的满意结果似乎得益于网膜成形术与负压封闭引流系统的联合应用。这些发现使我们在盆腔脏器清除术伴有高感染风险的情况下倾向于使用负压封闭引流系统。
