Aleksic M, Hennes N, Schmitz-Dräger B J, Ulrich B
Chirurgische Klinik, Krankenhaus Gerresheim, Kliniken der Landeshauptstadt Düsseldorf.
Chirurg. 1998 Apr;69(4):450-4. doi: 10.1007/s001040050437.
From 1988 to 1996 we performed 18 total pelvic exenterations in patients with an average age of 59.8 years who could be followed up for a mean 29.8 months. In 10 cases a recurrent tumor of the pelvic viscera and 7 times a primary carcinoma of the rectum, bladder or prostate were treated. In 1 patient a radiogenic fistula led to this operation. Intestinal continuity could be reconstructed in 7 cases. Following cystectomy, urinary diversion was accomplished in half of the cases by an ileal conduit. Due to septic multiorgan failure 2 patients died postoperatively (hospital mortality rate 11%). In 82% a complete resection (R0) was possible. Subsequently 5 patients (29%) developed tumor recurrence. Distant metastases were observed in 3 patients, 8-9 months after surgery. So far 10 further patients have died. Their mean survival time was 28.9 months (range 5-99 months). The remaining 6 patients are still alive between 22 and 36 months postoperatively. Despite the extent of this kind of major surgery, which also requires multidisciplinary cooperation, and the psychosocial problems resulting from two permanent stomas, total pelvic exenteration should be regarded as an adequate alternative in the treatment plan in selected patients with locally advanced or recurrent pelvic disease.
1988年至1996年期间，我们对平均年龄为59.8岁的患者进行了18例全盆腔脏器切除术，这些患者的平均随访时间为29.8个月。其中10例为盆腔脏器复发肿瘤，7例为直肠、膀胱或前列腺原发性癌。1例患者因放射性瘘管而接受此手术。7例患者重建了肠道连续性。膀胱切除术后，半数患者通过回肠造口术进行尿流改道。由于感染性多器官功能衰竭，2例患者术后死亡（医院死亡率11%）。82%的患者实现了根治性切除（R0）。随后，5例患者（29%）出现肿瘤复发。3例患者在术后8 - 9个月出现远处转移。到目前为止，又有10例患者死亡。他们的平均生存时间为28.9个月（范围为5 - 99个月）。其余6例患者术后22至36个月仍存活。尽管这类大手术范围广，还需要多学科合作，且存在两个永久性造口带来的心理社会问题，但对于局部晚期或复发性盆腔疾病的特定患者，全盆腔脏器切除术仍应被视为治疗方案中的一种合适选择。
