Viville C
J Urol (Paris). 1995;101(2):65-8.
This survey was conducted by 28 urologists members of the ANFUC who reported rectal wounds observed during radical prostatectomy procedures performed for cancer. There were 1,816 procedures reported, 1,785 suprapubic prostatectomies and 28 perineal operations. Kraske access was used in 3 cases. There were 33 wounds to the rectum reported by 17 operators including 31 in suprapubic prostatectomies (1.7% of the operations) and 2 after transperineal operations (7.14%). Preoperative radiotherapy was never used and mechanical preparation was performed in most of the cases with rectal complications (27/33). The wound was sutured in all cases and a colonic derivation was required in 4. Retrospectively this procedure was judged unnecessary in 2 or 3 cases. The post-operative period was uneventful in all cases and the derivations were closed 2 or 3 months later. The conclusions drawn from this survey were the following: the rate of rectal complications in radical prostatectomy is higher in the perineal route. When no preoperative radiotherapy has been performed, simple suture of the rectal wound is sufficient and colonic derivation is not always necessary. It does not appear necessary to interpose an epiploic flap in such cases which would have the disadvantage of requiring opening the peritoneal cavity. These considerations are only applicable to the nonirradiated rectum. Preoperative radiotherapy would undoubtedly have a major effect, but we have had no experience in this series.
这项调查由阿根廷泌尿外科学会（ANFUC）的28名泌尿外科医生成员开展，他们报告了在因癌症进行的根治性前列腺切除术过程中观察到的直肠伤口情况。共报告了1816例手术，其中1785例耻骨上前列腺切除术和28例会阴部手术。3例使用了克拉斯克入路。17名手术医生报告了33例直肠伤口，其中31例发生在耻骨上前列腺切除术中（占手术的1.7%），2例发生在经会阴手术后（占7.14%）。从未进行术前放疗，大多数发生直肠并发症的病例（27/33）进行了机械肠道准备。所有病例的伤口均进行了缝合，4例需要进行结肠造口术。回顾性分析认为，其中2至3例的该手术并无必要。所有病例术后恢复顺利，造口在2至3个月后关闭。本次调查得出的结论如下：根治性前列腺切除术中经会阴途径的直肠并发症发生率更高。在未进行术前放疗的情况下，直肠伤口简单缝合即可，并不总是需要进行结肠造口术。在此类情况下似乎没有必要置入网膜瓣，因为这会带来打开腹腔的弊端。这些考虑仅适用于未接受放疗的直肠。术前放疗无疑会产生重大影响，但本系列研究中我们并无这方面的经验。
