De Wever Ivo
Department of Surgical Oncology, Leuven University Hospital, Leuven, Belgium.
Acta Chir Belg. 2011 Sep-Oct;111(5):273-81.
The aim of this study was to report the surgical results in a series of pelvic exenterations, its peroperative difficulties, postoperative complications, mortality and long-term complications.
Between November 1980 and December 2008, pelvic exenteration with curative intent has been performed in 106 patients, 87 female and 19 male, for gynecologic malignancy in 69, intestinal tumors in 29, urologic in 6 and advanced skin carcinomas in 2. The exenteration was performed as primary treatment in only 21 patients, in the others it was for persistent or recurrent tumors after radiotherapy and/or surgery.
In 86 patients a total exenteration was performed and in 55 the resection involved an extension beyond the classical planes of dissection. An incontinent urinary diversion was made in 100 patients, a colo-anal anastomis in 35, omentoplasty was standard and muscle flaps were used in 15 patients. Blood loss necessitating transfusion of more than 10 packed cell units or gauze packing did occur in 27 patients with extended resection. Postoperative complications occurred in 64 patients necessitating relaparotomy in 14. Mortality within 30 days was 2%, in hospital 5% but did not occur in the last 44 patients. During the very long follow-up serious late complications were observed in the kidneys of 12 patients and in the small bowel of 5.
Pelvic exenteration is still a major surgical undertaking with a 60% complication rate but can nowadays be performed with a low mortality. Postoperative complications were related to radiotherapy dose above 50 Gy, extension of dissection, the empty pelvis, the urinary diversion and the small intestine. A protected colo-anal anastomosis should be offered when the pelvic floor can be conserved and muscle flaps should be considered after total infralevatoric exenteration. Bricker's urinary diversion still is the golden standard. Long-term complications were observed in 40 patients requiring surgery in 19.
本研究的目的是报告一系列盆腔脏器清除术的手术结果、术中困难、术后并发症、死亡率及远期并发症。
1980年11月至2008年12月期间，106例患者接受了根治性盆腔脏器清除术，其中女性87例，男性19例。69例因妇科恶性肿瘤，29例因肠道肿瘤，6例因泌尿系统肿瘤，2例因晚期皮肤癌。仅21例患者将盆腔脏器清除术作为初始治疗，其他患者则是针对放疗和/或手术后的持续性或复发性肿瘤。
86例患者进行了全盆腔脏器清除术，55例的切除范围超出了传统的解剖平面。100例患者进行了尿流改道术，35例进行了结肠肛管吻合术，均常规行网膜成形术，15例患者使用了肌皮瓣。27例扩大切除术患者出现失血过多，需要输注超过10个单位的浓缩红细胞或进行纱布填塞。64例患者出现术后并发症，其中14例需要再次剖腹手术。30天内死亡率为2%，住院期间死亡率为5%，但最近44例患者未出现死亡。在长期随访中，12例患者的肾脏和5例患者的小肠出现了严重的晚期并发症。
盆腔脏器清除术仍然是一项重大的外科手术，并发症发生率为60%，但如今死亡率较低。术后并发症与放疗剂量超过50 Gy、解剖范围扩大、盆腔空虚、尿流改道及小肠有关。当可以保留盆底时，应采用保护性结肠肛管吻合术，全盆底以下脏器清除术后应考虑使用肌皮瓣。Bricker尿流改道术仍是金标准。40例患者出现远期并发症，其中19例需要手术治疗。
