Chang Suk Joon, Bristow Robert E
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, Orange, CA, USA.
J Gynecol Oncol. 2015 Apr;26(2):155. doi: 10.3802/jgo.2015.26.2.155.
The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus, pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients with widespread pelvic involvement.
The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacent pelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic disease within this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying the bladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vessels are divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon is divided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesentery is ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed and dissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to the left of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in a retrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosis was completed using stapling device.
En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvic disease leaving no gross residual disease was possible using en bloc pelvic resection.
En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic disease in advanced primary ovarian cancer patients with extensive pelvic organ involvement.
本文旨在描述晚期上皮性卵巢癌盆腔广泛受累患者行附件肿瘤、子宫、盆腔腹膜及直肠乙状结肠整块切除并结直肠吻合术的手术细节。
该患者身体状况良好，但盆腔巨大肿瘤广泛浸润至相邻盆腔器官并闭塞直肠子宫陷凹。患者接受了整块盆腔切除术作为初次肿瘤细胞减灭术。整块盆腔切除术首先进行环形腹膜切口，将所有盆腔疾病包含在该切口内。在进行腹膜后盆腔解剖后，切断圆韧带和骨盆漏斗韧带。游离输尿管并使其与腹膜分离。在分离覆盖膀胱及其肿瘤结节的前盆腔腹膜后，将膀胱向尾侧游离并形成膀胱阴道间隙。在输尿管水平切断子宫血管，并切断宫颈旁组织（或子宫旁组织）。使用结扎和切割吻合器在肉眼可见肿瘤最近端上方切断乙状结肠近端。结扎并切断乙状结肠系膜，包括直肠上血管。进一步扩大直肠旁和直肠后间隙并向下解剖至盆底。向后解剖，先向直肠右侧，再向左侧进行。结扎并切断包括直肠中血管在内的直肠柱。逆行完成子宫切除术。使用直线吻合器切断直肠远端。将标本与子宫、附件、盆腔腹膜、直肠乙状结肠及肿瘤块一并整块切除，使盆腔肉眼无肿瘤残留。使用吻合器完成结直肠吻合术。
通过全腹子宫切除术、双侧输卵管卵巢切除术、盆腔腹膜切除术及直肠乙状结肠切除术并使用吻合器进行结直肠吻合术，完成了整块盆腔切除术。使用整块盆腔切除术可实现盆腔疾病的完全清除，无肉眼残留病灶。
对于晚期原发性卵巢癌盆腔器官广泛受累的患者，整块盆腔切除术对于实现最大程度的肿瘤细胞减灭及消除盆腔疾病是有效的。
