Van Haecke P, Vitaux J, Michot F, Hay J M, Flamant Y, Maillard J N
Nouv Presse Med. 1981 Mar 7;10(11):879-83.
Thirteen patients with intestinal lesions consecutive to radiotherapy for carcinoma of the uterus were operated upon between 1973 and 1979. The small bowel was involved in 9 patients and the colon and rectum in 4 patients. Urinary tract lesions were associated in 3 patients of each group. Intestinal necrosis, progression of the lesions and extensive pelvic fibrosis were the only criteria of poor prognosis. Twenty-two operations were performed: 4 for urinary tract lesions and 18 for intestinal lesions. Five patients died during the immediate post-operative period and five died within 2 to 30 months after surgery, including 4 whose carcinoma recurred. The operative technique should be selected according to the extent and severity of radiation-induced damage, as determined by pre-operative examination and thorough exploration of the abdominal cavity once opened. Limited lesions of the small bowel can be treated by resection, but intestinal bypass with latero-lateral anastomosis seems to be preferable in cases with extensive lesions. Patients with colorectal lesions should have defunctioning colostomy prior to any other procedure dictated by the state of affairs. Multiple anastomosis, extensive resections and excessive dissections should be avoided.
1973年至1979年间，对13例子宫癌放疗后出现肠道病变的患者进行了手术。9例患者小肠受累，4例患者结肠和直肠受累。每组各有3例患者伴有泌尿系统病变。肠道坏死、病变进展和广泛的盆腔纤维化是预后不良的唯一标准。共进行了22次手术：4次针对泌尿系统病变，18次针对肠道病变。5例患者在术后即刻死亡，5例在术后2至30个月内死亡，其中4例癌症复发。手术技术应根据术前检查及打开腹腔后对腹腔的全面探查所确定的放射损伤程度和严重性来选择。小肠局限性病变可通过切除治疗，但对于广泛病变，侧侧吻合的肠旁路术似乎更可取。患有结直肠病变的患者在根据具体情况决定进行任何其他手术之前应先行造口术。应避免多次吻合、广泛切除和过度解剖。
