Angele M K, Khalil P N, Spelsberg F, Bruns C J, Burges A, Jauch K-W, Kleespies A
Klinikum der Universität München - Campus Großhadern, Klinik und Poliklinik für Chirurgie, München, Deutschland.
Zentralbl Chir. 2011 Jun;136(3):237-43. doi: 10.1055/s-0030-1262755. Epub 2011 Feb 17.
Tumours of the female genital tract are often diagnosed at an advanced stage or re-lapse after initial curative therapy. Ovarian cancer is in particular associated with peritoneal carcinomatosis or local tumour progression entailing different intestinal complications.
Based on our own results and a systemic PubMed search, different intestinal complications in non-curable tumours of the female genital tract were defined and different surgical and non-surgical therapeutic options were analysed.
Stenosis of the small bowel is often caused by direct infiltration of the tumour. Peritoneal carcinomatosis or postoperative abdominal adhesions may lead to an acute or even more often chronic recurrent obstruction. The rectum or sigmoid colon is in particular affected by stenosis caused by tumour masses within the pelvis, occurring fistulas or direct tumour infiltration which may lead to bleeding complications or a large bowel obstruction. Radiation-induced abdominal adhesions or stenosis of the small bowel as well as radiation-induced chronic proctocolitis are further common abdominal complications. Special attention with regard to a well balanced indication towards surgical, oncological or conservative management must be given in the palliative setting of the genital tract.
In particular the dictum of "primum nihil nocere" has to be followed in consideration of the patient's declared intention, the patient's prognosis, general condition, psychological strain as well as the expected complications.
女性生殖道肿瘤往往在晚期才被诊断出来，或者在初始治愈性治疗后复发。卵巢癌尤其与腹膜癌转移或局部肿瘤进展相关，会引发不同的肠道并发症。
基于我们自己的研究结果并通过系统性的PubMed检索，对女性生殖道不可治愈肿瘤的不同肠道并发症进行了定义，并分析了不同的手术和非手术治疗方案。
小肠狭窄常由肿瘤的直接浸润引起。腹膜癌转移或术后腹部粘连可能导致急性甚至更常见的慢性复发性肠梗阻。直肠或乙状结肠尤其容易受到盆腔内肿瘤肿块引起的狭窄、出现的瘘管或肿瘤直接浸润的影响，这可能导致出血并发症或大肠梗阻。放射性腹部粘连或小肠狭窄以及放射性慢性直肠结肠炎是另外常见的腹部并发症。在生殖道姑息治疗中，必须特别关注对手术、肿瘤学或保守治疗的恰当平衡的适应症。
尤其必须遵循“首要的是不伤害”这一格言，同时要考虑患者的明确意愿、患者的预后、一般状况、心理压力以及预期的并发症。
