Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
Division of Urology, Ohio State University College of Medicine, Columbus, OH, USA.
Gynecol Oncol. 2013 Jan;128(1):60-64. doi: 10.1016/j.ygyno.2012.08.004. Epub 2012 Aug 11.
To assess complications associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion (SUD).
A single institution retrospective chart review was conducted of all patients who underwent a pelvic exenteration between 2000 and 2011. Patients were included if the procedure involved at least a urinary diversion and a perineal phase. Patient demographics and complications in the first 6months after surgery were recorded.
Thirty-three patients met inclusion criteria (12 DBWC and 21 SUD). The majority of patients had recurrent cervical cancer (58%) followed by vaginal, vulva, and endometrial cancer. All patients had previously received radiation. 10/12 patients with a DBWC and 67% of SUD had pelvic reconstruction. Median length of stay (LOS) was shorter for DBWC (14.5 vs. 20days, p=.01). Median operating times were shorter for DBWC (610 vs. 702minutes, p=.04). No urinary conduit or anastomotic bowel leaks occurred in the DBWC group compared to 5 (24%) and 2 (9.5%), respectively, in the SUD group (p=.06 for any leak). 58% of the DBWC and 62% of the SUD group required re-operation, and there were no 30-day peri-operative deaths.
DBWC can be performed safely at the time of pelvic exenteration. We found reduced operating times, shorter LOS, and a trend toward fewer urinary conduit and/or bowel anastomotic leaks in DBWC exenteration patients. DBWC may be favorable over more technically challenging SUD in this heavily radiated population that generally has a limited overall survival.
评估盆腔廓清术后 6 个月内双套管湿造口（DBWC）与单独的尿粪分流（SUD）相关的并发症。
对 2000 年至 2011 年间行盆腔廓清术的所有患者进行了单中心回顾性病历回顾。如果手术至少涉及尿路分流和会阴阶段，则纳入患者。记录患者人口统计学特征和术后 6 个月内的并发症。
33 例患者符合纳入标准（12 例 DBWC 和 21 例 SUD）。大多数患者患有复发性宫颈癌（58%），其次是阴道癌、外阴癌和子宫内膜癌。所有患者均曾接受过放疗。12 例 DBWC 中有 10 例和 SUD 中有 67%进行了盆腔重建。DBWC 的中位住院时间（LOS）较短（14.5 天 vs. 20 天，p=.01）。DBWC 的中位手术时间较短（610 分钟 vs. 702 分钟，p=.04）。与 SUD 组的 5 例（24%）和 2 例（9.5%）相比，DBWC 组无一例发生尿导管或吻合口肠漏（p=.06 用于任何漏）。DBWC 组和 SUD 组的 58%需要再次手术，无 30 天围手术期死亡。
盆腔廓清术时可安全施行 DBWC。我们发现 DBWC 手术时间更短、住院时间更短，且 DBWC 组尿导管和/或肠吻合口漏的发生率有降低趋势。对于接受广泛放疗、总生存期通常有限的患者，DBWC 可能优于技术上更具挑战性的 SUD。
