Rubin S C, Benjamin I, Hoskins W J, Pierce V K, Lewis J L
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York 10021.
Gynecol Oncol. 1989 Jul;34(1):30-3. doi: 10.1016/0090-8258(89)90100-5.
Intestinal surgery is frequently required in the management of patients with gynecologic malignancies. During a recent 3-year period 10.4% of all laparotomies performed on the Gynecology Service at Memorial Sloan-Kettering Cancer Center included major intestinal surgery. A total of 215 separate intestinal procedures were performed during 171 operations on 158 patients. The majority of operations were performed in patients with ovarian (42.7%), cervical (24%), and endometrial (12.3%) malignancies. Seventy-nine of 171 (46.2%) of operations were performed on previously irradiated patients. The most frequent indications for intestinal surgery were intestinal obstruction (43.2%) and intestinal fistula (21%). Procedures performed included 87 intestinal resections, 26 intestinal bypasses, 82 colostomies, and 20 intestinal conduit urinary diversions. Hand suturing was used in 71% of anastomoses; automatic stapling instruments were used in 29%. There was a single surgical mortality. Complications including infections, obstruction, and fistula formation were infrequent. These difficult intestinal procedures can be performed safely in the context of a fellowship training program. Since a significant proportion of all laparotomies done in gynecologic cancer patients will include major intestinal surgery, physicians managing patients with these diseases should have both the technical skills necessary to perform these procedures, as well as a thorough understanding of the diseases themselves.
妇科恶性肿瘤患者的治疗常常需要进行肠道手术。在最近3年里，纪念斯隆-凯特琳癌症中心妇科服务部进行的所有剖腹手术中，10.4%包括大型肠道手术。在对158例患者进行的171次手术中，总共进行了215例单独的肠道手术。大多数手术是针对患有卵巢癌（42.7%）、宫颈癌（24%）和子宫内膜癌（12.3%）的患者进行的。171例手术中有79例（46.2%）是对先前接受过放疗的患者进行的。肠道手术最常见的指征是肠梗阻（43.2%）和肠瘘（21%）。所进行的手术包括87例肠切除术、26例肠旁路术、82例结肠造口术和20例肠道代膀胱术。71%的吻合口采用手工缝合；29%采用自动吻合器械。手术死亡1例。包括感染、梗阻和瘘管形成在内的并发症并不常见。在专科培训项目的背景下，可以安全地进行这些复杂的肠道手术。由于妇科癌症患者进行的所有剖腹手术中有很大一部分将包括大型肠道手术，治疗这些疾病患者的医生应具备进行这些手术所需的技术技能，以及对疾病本身的透彻了解。
