Patel H, Joseph J V, Amodeo A, Kothari K
Section of Laparoscopic Urology, Institute of Urology, University College Hospital, London, UK.
J Minim Access Surg. 2009 Oct;5(4):111-4. doi: 10.4103/0972-9941.59310.
Indications for total pelvic exenteration in a male (removal of the bladder, prostate and rectum) and in a woman (removal bladder, uterus, vagina, ovaries and rectum) are rare. The advanced stage generally dictates that the patient has some form of chemotherapy or radiotherapy, or a combination of two to shrink/debulk the tumour. We report the first two cases of a salvage laparoscopic total pelvic exenteration in a male for rectal adenocarcinoma invading into the bladder and prostate, post-chemo-radiotherapy and in a woman for squamous cell carcinoma of cervix invading the bladder and rectum post-chemo-radiotherapy. Salvage surgery is often difficult and has been noted to have high morbidity. Applying a laparoscopic approach to this group may have advantages for the patient and the surgeon, i.e. less pain, early recovery and magnified views. As we have technically shown it to be possible, perhaps laparoscopic approaches should be discussed if the teams in these centres are of advanced laparoscopic surgeons working in multi-skilled groups.
男性全盆腔脏器切除术（切除膀胱、前列腺和直肠）及女性全盆腔脏器切除术（切除膀胱、子宫、阴道、卵巢和直肠）的适应证较为罕见。晚期病例通常需要患者接受某种形式的化疗或放疗，或两者联合，以缩小肿瘤体积或减少肿瘤负荷。我们报告了首例两例挽救性腹腔镜全盆腔脏器切除术病例，一例为男性直肠腺癌侵犯膀胱和前列腺，经放化疗后进行手术；另一例为女性宫颈鳞状细胞癌侵犯膀胱和直肠，经放化疗后进行手术。挽救性手术通常难度较大，且并发症发生率较高。对这组患者采用腹腔镜手术方法可能对患者和外科医生都有好处，比如疼痛减轻、恢复快以及视野放大。由于我们已从技术上证明其可行性，如果这些中心的团队由经验丰富的腹腔镜外科医生组成且具备多学科技能，或许应探讨采用腹腔镜手术方法。
