Barnhill D, Doering D, Remmenga S, Bosscher J, Nash J, Park R
Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Gynecol Oncol. 1991 Jan;40(1):38-41. doi: 10.1016/0090-8258(91)90082-g.
A retrospective review covering a 9-year period revealed 113 patients who underwent 157 major bowel procedures during 130 operations performed solely by gynecologic oncology surgeons. Forty-eight percent of the operations were done for tumor cytoreduction, and 33% were performed for a bowel obstruction. Other indications included colostomy closure, fistula repair, resection for multiple enterotomies, temporary diversions, repair of perforated bowel, treatment for severe proctosigmoiditis, management of ureteral stricture, treatment for vulvar necrosis, and resection of an incidental small bowel tumor. Of the 157 procedures, 44% were colostomies, 32% were bowel resections with reanastomosis, 9% were urinary conduits, 6% were intestinal bypass procedures, 5% were colostomy closures, and 4% were ileostomies. Postoperative complications occurred in 32% of the 130 operations. These included wound infection, death, sepsis, fistula formation, urinary tract infection, unexplained febrile morbidity, anastomotic leakage, stomal infarction, adult respiratory distress syndrome, bowel obstruction, deep venous thrombosis, and wound hematoma. Four of the eight deaths were due to tumor progression, three were from sepsis, and one was from adult respiratory distress syndrome. Of the 130 operations, 89 (68%) were associated with no complications. These data support the concept that gynecologic oncology surgeons are able to perform intestinal operations as therapy for gynecologic malignancies with acceptable complication rates. Since a thorough understanding of the natural history of the cancer, familiarity with alternative therapeutic options, and knowledge of the prognosis are important in making operative decisions, and since gynecologic oncologists are technically capable of performing operations on the small bowel and colon, referral of patients with a primary or recurrent gynecologic malignancy or with a subsequent intestinal complication after initial therapy should be directed to the gynecologic oncologist whenever possible.
一项涵盖9年的回顾性研究显示，113例患者在仅由妇科肿瘤外科医生进行的130次手术中接受了157次大肠主要手术。48%的手术是为了肿瘤细胞减灭术，33%是为了肠梗阻进行的。其他适应证包括结肠造口闭合术、瘘管修复术、多处肠切开术切除术、临时改道术、肠穿孔修补术、严重直肠乙状结肠炎治疗、输尿管狭窄处理、外阴坏死治疗以及偶然发现的小肠肿瘤切除术。在157例手术中，44%是结肠造口术，32%是肠切除吻合术，9%是尿流改道术，6%是肠道旁路手术，5%是结肠造口闭合术，4%是回肠造口术。130例手术中有32%发生了术后并发症。这些并发症包括伤口感染、死亡、脓毒症、瘘管形成、尿路感染、不明原因的发热性疾病、吻合口漏、造口梗死、成人呼吸窘迫综合征、肠梗阻、深静脉血栓形成和伤口血肿。8例死亡中有4例是由于肿瘤进展，3例是由于脓毒症，1例是由于成人呼吸窘迫综合征。在130例手术中，89例（68%）没有并发症。这些数据支持了这样一个概念，即妇科肿瘤外科医生能够进行肠道手术作为妇科恶性肿瘤的治疗方法，且并发症发生率可接受。由于对癌症自然史的透彻理解、对替代治疗选择的熟悉以及对预后的了解在做出手术决策时很重要，并且由于妇科肿瘤学家在技术上有能力对小肠和结肠进行手术，所以只要有可能，原发性或复发性妇科恶性肿瘤患者或初始治疗后出现肠道并发症的患者应转诊至妇科肿瘤学家处。
