Horch Raymund E, Ludolph Ingo, Cai Aijia, Weber Klaus, Grützmann Robert, Arkudas Andreas
Department of Plastic and Hand Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany.
Department of Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany.
Front Oncol. 2020 May 13;10:719. doi: 10.3389/fonc.2020.00719. eCollection 2020.
Relapsing or far advanced rectal and anal cancers remain difficult to treat and require interdisciplinary approaches. Due to modern standard protocols all patients receive irradiation and neoadjuvant chemotherapy-and in case of a relapse a second irradiation-rendering the surgical site prone to surgical site infections and oftentimes long lasting sinus and septic complications after exenteration in the pelvis. Despite an improved overall survival rate in these patients the downside of radical tumor surgery in the pelvis is a major loss of quality of life, especially in women when parts of the vagina need to be resected. Derived from our experince with over 300 patients receiving pelvic and perineal reconstruciton with a transpelvic vertical rectus abdominis myocutaneous (tpVRAM) flap we studied the impact of this surgical technique on the outcomes of female patients with or without vaginal reconstruction following pelvic exenteration. We found out that the tpVRAM flap is reliably perfused and helps to reduce long term wound healing desasters in the irradiated perineal/vaginal/gluteal region.
复发性或晚期直肠癌和肛管癌仍然难以治疗，需要采用多学科方法。由于现代标准方案，所有患者都接受放疗和新辅助化疗，而复发性患者则接受二次放疗，这使得手术部位容易发生手术部位感染，并且在盆腔脏器清除术后常常出现长期的窦道和败血症并发症。尽管这些患者的总体生存率有所提高，但盆腔根治性肿瘤手术的不利之处在于生活质量大幅下降，尤其是对于需要切除部分阴道的女性患者。基于我们对300多名接受经盆腔垂直腹直肌肌皮瓣（tpVRAM）进行盆腔和会阴重建患者的经验，我们研究了这种手术技术对盆腔脏器清除术后进行或未进行阴道重建的女性患者预后的影响。我们发现，tpVRAM瓣血供可靠，有助于减少放疗后的会阴/阴道/臀区长期伤口愈合问题。
