Bricker E M, Johnston W D, Kraybill W G, Lopez M J
Am J Clin Oncol. 1984 Feb;7(1):81-9. doi: 10.1097/00000421-198402000-00011.
Severe damage to the pelvic viscera is a complication of irradiation therapy that, unfortunately, cannot always be avoided. Resulting rectal and rectocolonic strictures, rectovaginal fistulas, and shortening and stenosis of the vagina present very difficult problems that frequently require a colostomy for relief and may permanently impair sexual function. The authors present a new approach to correction of these unfortunate lesions based on the use of proximal nonirradiated colon which serves as a vascular pedicle graft to correct the defect without a complicated and massive resection. Twenty-two such operations have been done with 19 satisfactory to excellent results and two total failures (one death from small bowel complications). All patterns and combinations of irradiation injury have been found amenable to this technique of repair. These have included both web and linear strictures with and without fistulas. In half of the patients, it was possible to make use of normal colon bypassed by a prior colostomy. Normal nonirradiated colon with good blood supply will heal satisfactorily to irradiated colon or rectum, thus making excision of all the irradiated tissue unnecessary. The results of this surgical approach have thus far been gratifying and warrant further trials for these distressing injuries.
盆腔脏器的严重损伤是放射治疗的一种并发症，遗憾的是，这种并发症并非总能避免。由此导致的直肠和直肠结肠狭窄、直肠阴道瘘以及阴道缩短和狭窄，会带来非常棘手的问题，常常需要进行结肠造口术来缓解症状，而且可能会永久性地损害性功能。作者提出了一种新的方法来矫正这些不良病变，该方法基于使用未受照射的近端结肠，将其作为带血管蒂移植物来矫正缺损，而无需进行复杂的大规模切除。已进行了22例此类手术，其中19例效果令人满意至极佳，2例完全失败（1例死于小肠并发症）。已发现所有类型和组合的放射损伤都适用于这种修复技术。这些损伤包括伴有或不伴有瘘管的蹼状和线性狭窄。在一半的患者中，可以利用先前结肠造口术绕过的正常结肠。血液供应良好的正常未受照射结肠与受照射的结肠或直肠愈合良好，因此无需切除所有受照射组织。到目前为止，这种手术方法的结果令人满意，值得对这些令人痛苦的损伤进行进一步试验。
