Deckers P J, Olsson C, Williams L A, Mozden P J
Am J Surg. 1976 Apr;131(4):509-15. doi: 10.1016/0002-9610(76)90166-5.
It has been traditional to exclude patients with radiation-recurrent carcinoma of the uterine cervix or other pelvic neoplasms, incapacitating pelvic pain, postirradiation fistulas, hemorrhage, or malodorous draining tumor necrosis from pelvic exenteration if cure of the malignant disease is not achievable. This negative attitude is a direct result of the reported high morbidity, prohibitive mortality, and low salvage rate previously associated with pelvic exenteration, the only acceptable surgical approach to these diseases. A recent experience with eighteen patients who underwent pelvic exenteration for advanced primary or recurrent carcinoma of the cervix, urinary bladder, or rectum has led us to challenge several traditional concepts regarding this operative procedure. We have observed but one operative death and our morbidity has been minimal. This may reflect our belief that an aggressive pelvic lymphadenectomy in those patients with direct visceral involvement from radiation-recurrent carcinoma of the pelvic viscera is not advantageous since no significant survival has ever been documented for patients with pathologic visceral involvement and positive lymph nodes. In addition, significant morbidity has always been associated directly with pelvic lymphadenectomy in the irradiated pelvis, and elimination of this phase of the operation in selected patients with radiation-recurrent carcinoma is indicated. Moreover, the considerable decrease in morbidity and the minimal mortality observed have led us to adopt a very liberal attitude toward preoperative selection criteria, and we regularly now use pelvic exenteration not only for cure but as intentional palliation in selected patients. We strongly believe that elimination of pain, fistulas, pelvic sepsis, hemorrhage, and malodorous areas of tumor necrosis are important for improving the quality of life for both the patient and family.
传统上，如果无法治愈恶性疾病，患有子宫颈放射复发性癌或其他盆腔肿瘤、导致功能丧失的盆腔疼痛、放疗后瘘管、出血或有恶臭引流的肿瘤坏死的患者会被排除在盆腔脏器清除术之外。这种消极态度是此前报道的盆腔脏器清除术高发病率、高死亡率和低挽救率的直接结果，而盆腔脏器清除术是治疗这些疾病唯一可接受的手术方法。最近对18例因晚期原发性或复发性子宫颈癌、膀胱癌或直肠癌接受盆腔脏器清除术的患者的经验，促使我们对有关该手术的几个传统观念提出质疑。我们仅观察到1例手术死亡，且发病率极低。这可能反映了我们的观点，即对于那些因盆腔脏器放射复发性癌而直接累及内脏的患者，进行积极的盆腔淋巴结清扫术并无益处，因为对于有病理内脏受累且淋巴结阳性的患者，从未有过显著生存获益的记录。此外，在接受过放疗的盆腔中，显著的发病率一直与盆腔淋巴结清扫术直接相关，因此对于某些放射复发性癌患者，应取消这一手术阶段。而且，观察到的发病率显著降低和死亡率极低，使我们对术前选择标准采取了非常宽松的态度，我们现在经常将盆腔脏器清除术不仅用于治愈，还用于某些患者的姑息治疗。我们坚信，消除疼痛、瘘管、盆腔感染、出血和有恶臭的肿瘤坏死区域对于提高患者及其家人的生活质量至关重要。
