Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
Gynecol Oncol. 2011 Apr;121(1):131-4. doi: 10.1016/j.ygyno.2010.11.044. Epub 2011 Jan 21.
To examine outcomes after pelvic exenteration in women treated with modern chemoradiation and surgical techniques.
All patients at our institution with a diagnosis of gynecologic malignancy who underwent pelvic exenteration after treatment with chemoradiation between 1/90 and 6/08 were evaluated with a retrospective chart review.
44 women were identified, of whom 29 (66%) had cervical, 6 (14%) had uterine, 5 (11%) had vaginal, and 4 (9%) had vulvar cancer. The majority of patients (82%) were initially treated with external beam whole-pelvic radiation with concurrent cisplatin. 38 patients (86%) underwent exenteration for a central pelvic recurrence, and the remaining 6 patients (14%) for radiation necrosis. The most common surgical complication was transfusion requirement in 36 patients (82%), followed by wound infection in 15 (34%), small bowel obstruction in 8 (18%), and sepsis in 6 (14%). The median time spent in the ICU post-operatively was 2 days. One patient (2%) died during her post-operative hospital stay. The mean EBL overall was 2497 cc and the mean operative time was 544 min. Use of electrothermal bipolar coagulation, which was used in 64% of the exenterations, significantly reduced blood loss (3679 cc vs. 1836 cc, p=0.014). After exenteration, 21 patients (48%) were diagnosed with a recurrence of cancer, and the mean progression free survival was 31 months. Patients who received exenteration less than 2 years after their initial chemoradiation had a significantly shorter overall survival time (8 months vs. 33 months, p=0.016).
Approximately 50% of women develop recurrence following exenterations done after chemoradiation. Survival is significantly longer in patients who necessitate exenteration greater than 2 years out from initial treatment. Electrothermal bipolar coagulation appears to significantly reduce blood loss during these surgeries.
检查采用现代放化疗和手术技术治疗的女性行盆腔廓清术后的结局。
对我院于 1990 年 1 月至 2008 年 6 月间接受放化疗后行盆腔廓清术的妇科恶性肿瘤患者进行回顾性病历分析。
共纳入 44 名患者，其中 29 名（66%）患有宫颈癌，6 名（14%）患有子宫内膜癌，5 名（11%）患有阴道癌，4 名（9%）患有外阴癌。大多数患者（82%）最初接受盆腔外照射联合顺铂同步化疗。38 名（86%）患者因中央盆腔复发行廓清术，6 名（14%）患者因放射性坏死行廓清术。最常见的手术并发症是 36 名（82%）患者需要输血，其次是 15 名（34%）患者发生伤口感染，8 名（18%）患者发生小肠梗阻，6 名（14%）患者发生脓毒症。术后 ICU 中位时间为 2 天。1 名（2%）患者术后住院期间死亡。总的术中出血量平均为 2497cc，手术时间平均为 544 分钟。使用热电双极电凝的患者 22 名（64%），其出血量明显减少（3679cc 比 1836cc，p=0.014）。行盆腔廓清术后，21 名（48%）患者诊断为癌症复发，无进展生存时间平均为 31 个月。在初始放化疗后 2 年内行盆腔廓清术的患者总生存时间明显缩短（8 个月比 33 个月，p=0.016）。
大约 50%的女性在行放化疗后行盆腔廓清术后会复发。初始治疗后 2 年以上行盆腔廓清术的患者生存时间显著延长。热电双极电凝术似乎可显著减少这些手术中的出血量。
