Tashiro Jo, Yamaguchi Shigeki, Ishii Toshimasa, Suwa Hirokazu, Kondo Hiroka, Suzuki Asami, Miyazawa Mitsuo, Koyaman Isamu
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Case Rep Gastroenterol. 2013 Mar 23;7(1):175-81. doi: 10.1159/000350557. Print 2013 Jan.
Total pelvic exenteration for locally recurrent rectal cancer typically requires extensive excision of the pelvic floor with perineal skin. Due to the extensiveness of the procedure and its non-curative nature, it is controversial as purely palliative therapy. A 66-year-old male patient who had undergone abdominoperineal resection at another hospital 8 years prior was admitted to our hospital. During radiation and chemotherapy for 2 years, he complained of perineal pain, discharge, cacosmia and bleeding from a recurrent tumor. The 10 × 8 cm recurrent tumor was exposed on the perineum and the patient suffered from serious discomfort in his daily life during walking or sitting. We performed total pelvic exenteration with partial sacrectomy, after which the large perineal defect was reconstructed with a bilateral V-Y gluteus maximus advancement flap in approximately 120 min. The patient's postoperative course was satisfactory and his quality of life markedly improved.
局部复发性直肠癌的全盆腔脏器切除术通常需要广泛切除盆底及会阴皮肤。由于该手术范围广泛且并非根治性手术，作为单纯的姑息性治疗存在争议。一名66岁男性患者8年前在另一家医院接受了腹会阴联合切除术，现入住我院。在接受2年的放化疗期间，他主诉会阴疼痛、分泌物、恶臭及复发性肿瘤出血。会阴处可见一个10×8cm的复发性肿瘤，患者在行走或坐立时日常生活中感到严重不适。我们进行了全盆腔脏器切除术并部分骶骨切除，之后在大约120分钟内用双侧V-Y臀大肌推进皮瓣修复了巨大的会阴缺损。患者术后恢复过程顺利，生活质量明显改善。
