Goldberg J M, Piver M S, Hempling R E, Aiduk C, Blumenson L, Recio F O
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Ann Surg Oncol. 1998 Jul-Aug;5(5):399-406. doi: 10.1007/BF02303857.
Since pelvic exenteration for the treatment of recurrent gynecologic malignancy first was described, reported rates of morbidity and mortality have declined steadily. However, the factors responsible for this decline have never been clearly delineated.
We reviewed the charts of 154 patients who underwent pelvic exenteration for gynecologic malignancy between 1954 and 1994. Charts were abstracted for details of the surgical procedure, pathologic findings, postoperative management, short- and long-term complications, time to recurrence, and overall survival.
Seventy-two patients (47%) experienced 95 identifiable postoperative complications, resulting in death in 22 patients (14%). The rate of infectious complications declined to a statistically significant degree between the first two decades and latter two decades of the study (odds ratio [OR] 0.28. 95% CI 0.11-0.69). The use of routine prophylactic antibiotics was associated with this decline in infectious complications (OR 0.25, 95% CI 0.07-0.83). The use of preoperative subcutaneous heparin was associated with a reduction in thrombotic complications from 5 of 100 patients to 0 of 54 patients (P = .11), as well as a significant reduction in overall risk of complications (OR 0.53, 95% CI 0.33-0.85) and risk of postoperative mortality (OR 0.19, 95% CI 0.05-0.80). There was a significant reduction in overall risk of postoperative complications with both intensive care unit monitoring postoperatively (OR 0.65, 95% CI 0.43-0.99) and routine postoperative monitoring with a pulmonary artery catheter (OR 0.61, 95% CI 0.38-0.98).
Routine use of prophylactic antibiotics, prophylactic subcutaneous heparin, and intensive postoperative monitoring appear to have reduced morbidity from pelvic exenteration.
自从首次描述盆腔脏器清除术用于治疗复发性妇科恶性肿瘤以来，报道的发病率和死亡率稳步下降。然而，导致这种下降的因素从未被明确界定。
我们回顾了1954年至1994年间154例因妇科恶性肿瘤接受盆腔脏器清除术患者的病历。提取病历中的手术细节、病理结果、术后管理、短期和长期并发症、复发时间及总生存率等信息。
72例患者（47%）出现95种可识别的术后并发症，22例患者（14%）死亡。在研究的前二十年和后二十年之间，感染性并发症的发生率有统计学意义的下降（优势比[OR]0.28，95%可信区间0.11 - 0.69）。常规预防性使用抗生素与感染性并发症的下降相关（OR 0.25，95%可信区间0.07 - 0.83）。术前皮下注射肝素的使用与血栓形成并发症从100例中的5例降至54例中的0例相关（P = 0.11），同时总体并发症风险显著降低（OR 0.53，95%可信区间0.33 - 0.85）以及术后死亡风险降低（OR 0.19，95%可信区间0.05 - 0.80）。术后重症监护病房监测（OR 0.65，95%可信区间0.43 - 0.99）和术后常规使用肺动脉导管监测（OR 0.61，95%可信区间0.38 - 0.98）均使术后总体并发症风险显著降低。
常规使用预防性抗生素、预防性皮下肝素和强化术后监测似乎降低了盆腔脏器清除术的发病率。
