Orr J W, Shingleton H M, Hatch K D, Taylor P T, Partridge E E, Soong S J
Am J Obstet Gynecol. 1983 Feb 1;145(3):325-32. doi: 10.1016/0002-9378(83)90719-6.
Between October, 1969, and August, 1981, 125 pelvic exenterations were performed by gynecologic oncologists at the University of Alabama in Birmingham. One hundred twenty patients underwent an exenterative procedure that required urinary diversion and a gastrointestinal anastomosis. Gastrointestinal complications accounted for 60% of all nonmalignant indications for reoperation after exenteration. The common factor in the majority of gastrointestinal complications was the presence of an anastomosis in previously irradiated small bowel. Other preoperative factors, such as significant medical disease, previous laparotomy, or malnutrition, had little apparent effect on the rate of gastrointestinal complications. Avoidance of a small bowel anastomosis by means of a colon conduit, use of an omental pedicle to bring new blood supply into the pelvis, and hyperalimentation have reduced the risk of small bowel obstruction and fistula to 2.2%, while alteration in surgical technique has decreased the rectovaginal fistula rate to 5.3%.
1969年10月至1981年8月期间，阿拉巴马大学伯明翰分校的妇科肿瘤学家进行了125例盆腔脏器清除术。120例患者接受了需要尿路改道和胃肠吻合术的脏器清除手术。胃肠并发症占脏器清除术后所有非恶性再手术指征的60%。大多数胃肠并发症的共同因素是在先前接受过放疗的小肠中存在吻合口。其他术前因素，如严重内科疾病、既往剖腹手术或营养不良，对胃肠并发症发生率几乎没有明显影响。通过结肠导管避免小肠吻合、使用网膜蒂为盆腔带来新的血液供应以及胃肠外营养已将小肠梗阻和瘘的风险降低至2.2%，而手术技术的改变已将直肠阴道瘘发生率降至5.3%。
