• 四川大學華西醫(yī)院胃腸外科中心(四川成都 610041);

目的  總結低位直腸癌累及遠端陰道及會陰體時行后盆腔臟器切除及遠端陰道及會陰體切除后會陰重建的各種方法的應用體會。
方法  總結我院2008年10月至2013年9月期間收治的10例直腸癌聯(lián)合遠端陰道及會陰體切除后的重建方式及圍手術期的臨床資料。
結果  10例患者中2例行子宮及陰道全切除,3例行子宮及陰道后壁切除,5例行單純遠端陰道和(或)會陰體切除。分別采用大網(wǎng)膜填塞(4例)、陰道前壁翻轉縫合(3例)、子宮后傾(2例)、帶蒂乙狀結腸(2例)重建盆腔及陰道會陰缺損。1例患者盆腔嚴重感染,2例患者會陰部切口感染或裂開。
結論  女性低位直腸癌患者行后盆腔聯(lián)合臟器切除后切口相關并發(fā)癥率極高,可根據(jù)盆腔、會陰及陰道的缺損情況選用子宮或網(wǎng)膜填塞盆腔、帶蒂腸段或肌皮瓣、生物補片等方法進行一期修復缺損,采用腹直肌或臀大肌肌皮瓣修復會陰巨大缺損成為目前主流的修復方式,但國內(nèi)該技術報道極少,值得積極開展應用。

引用本文: 王自強,張元川,鄧祥兵,王默進,孟文建,魏明天,金成武. 低位直腸癌行后盆腔臟器切除聯(lián)合遠端陰道及會陰體切除術后會陰重建的方式及體會. 中國普外基礎與臨床雜志, 2013, 20(11): 1228-1233. doi: 復制

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2. 傅紅, 黃愷, 史向軍. 直腸癌腹會陰聯(lián)合根治術后會陰切口臨床處理進展[J]. 世界華人消化雜志, 2008, 16(1):1-4.
3. Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy[J]. Cancer, 1948, 1(2):177-183.
4. Yang TX, Morris DL, Chua TC. Pelvic exenteration for rectal cancer:a systematic review[J]. Dis Colon Rectum, 2013, 56(4):519-531.
5. Veazey PR, McBride CM. Pelvic recurrence of cancer after abdominoperineal resection of the rectum[J]. South Med J, 1979, 72(12):1545-1547.
6. Russ JE, Smoron GL, Gagnon JD. Omental transposition flap in colorectal carcinoma:adjunctive use in prevention and treatment of radiation complications[J]. Int J Radiat Oncol Biol Phys, 1984, 10(1):55-62.
7. Hultman CS, Sherrill MA, Halvorson EG, et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy:patient selection, technical caveats, and clinical outcomes[J]. Ann Plast Surg, 2010, 64(5):559-562.
8. 匡毅, 李福沛, 蔣又新, 等. 后盆臟器切除帶蒂乙狀結腸陰道修復術治療女性直腸癌[J]. 中國腫瘤臨床, 2012, 39(22):1853-1855.
9. 袁石初, 陸家齊, 焦華波. 直腸癌盆腔清掃術后帶蒂回腸段修復陰道[J]. 中國修復重建外科雜志, 1999, 13(2):86-87.
10. Lieberman RC, Feldman S. Primary closure of the perineal woundwith closed continuous transabdominal pelvic irrigation after rectalexcision[J]. Dis Colon Rectum, 1984, 27(8):526-528.
11. Buchel EW, Finical S, Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps[J]. Ann Plast Surg, 2004, 52(1):22-26.
12. Chessin DB, Hartley J, Cohen AM, et al. Rectus flap reconstr-uction decreases perineal wound complications after pelvic chemo-radiation and surgery:a cohort study[J]. Ann Surg Oncol, 2005,.
13. (2):104-110.
14. Foster JD, Pathak S, Smart NJ, et al. Reconstruction of the peri-neum following extralevator abdominoperineal excision for carcinoma of the lower rectum:a systematic review[J]. Colorectal Dis, 2012, 14(9):1052-1059.
15. McCraw JB, Massey FM, Shanklin KD, et al. Vaginal reconstr-uction with gracilis myocutaneous flaps[J]. Plast Reconstr Surg,.
16. Shibata D, Hyland W, Busse P, et al. Immediate reconstructionof the perineal wound with gracilis muscle flaps following abdom-inoperineal resection and intraoperative radiation therapy for recu-rrent carcinoma of the rectum[J]. Ann Surg Oncol, 1999, 6(1):33-37.
17. 王波, 王志國, 連海云, 等. 腰臀筋膜皮瓣修復骶部褥瘡的臨床應用[J]. 實用骨科雜志, 2003, 9(6):550.
18. Christensen HK, Nerstrøm P, Tei T, et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer[J]. Dis Colon Rectum, 2011, 54(6):711-717.
19. 朱麗莉, 卜麗文. 股薄肌皮瓣修復直腸癌腹會陰切除術后會陰缺損的護理[J]. 上海護理, 2005, 5(6):1-3.
20. Han JG, Wang ZJ, Gao ZG, et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection[J]. Dis Colon Rectum, 2010, 53(2):219-223.
21. , 58(2):176-183.
  1. 1. Bullard KM, Trudel JL, Baxter NN, et al. Primary perineal woundclosure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure[J]. Dis Colon Rectum, 2005, 48(3):438-443.
  2. 2. 傅紅, 黃愷, 史向軍. 直腸癌腹會陰聯(lián)合根治術后會陰切口臨床處理進展[J]. 世界華人消化雜志, 2008, 16(1):1-4.
  3. 3. Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy[J]. Cancer, 1948, 1(2):177-183.
  4. 4. Yang TX, Morris DL, Chua TC. Pelvic exenteration for rectal cancer:a systematic review[J]. Dis Colon Rectum, 2013, 56(4):519-531.
  5. 5. Veazey PR, McBride CM. Pelvic recurrence of cancer after abdominoperineal resection of the rectum[J]. South Med J, 1979, 72(12):1545-1547.
  6. 6. Russ JE, Smoron GL, Gagnon JD. Omental transposition flap in colorectal carcinoma:adjunctive use in prevention and treatment of radiation complications[J]. Int J Radiat Oncol Biol Phys, 1984, 10(1):55-62.
  7. 7. Hultman CS, Sherrill MA, Halvorson EG, et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy:patient selection, technical caveats, and clinical outcomes[J]. Ann Plast Surg, 2010, 64(5):559-562.
  8. 8. 匡毅, 李福沛, 蔣又新, 等. 后盆臟器切除帶蒂乙狀結腸陰道修復術治療女性直腸癌[J]. 中國腫瘤臨床, 2012, 39(22):1853-1855.
  9. 9. 袁石初, 陸家齊, 焦華波. 直腸癌盆腔清掃術后帶蒂回腸段修復陰道[J]. 中國修復重建外科雜志, 1999, 13(2):86-87.
  10. 10. Lieberman RC, Feldman S. Primary closure of the perineal woundwith closed continuous transabdominal pelvic irrigation after rectalexcision[J]. Dis Colon Rectum, 1984, 27(8):526-528.
  11. 11. Buchel EW, Finical S, Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps[J]. Ann Plast Surg, 2004, 52(1):22-26.
  12. 12. Chessin DB, Hartley J, Cohen AM, et al. Rectus flap reconstr-uction decreases perineal wound complications after pelvic chemo-radiation and surgery:a cohort study[J]. Ann Surg Oncol, 2005,.
  13. 13. (2):104-110.
  14. 14. Foster JD, Pathak S, Smart NJ, et al. Reconstruction of the peri-neum following extralevator abdominoperineal excision for carcinoma of the lower rectum:a systematic review[J]. Colorectal Dis, 2012, 14(9):1052-1059.
  15. 15. McCraw JB, Massey FM, Shanklin KD, et al. Vaginal reconstr-uction with gracilis myocutaneous flaps[J]. Plast Reconstr Surg,.
  16. 16. Shibata D, Hyland W, Busse P, et al. Immediate reconstructionof the perineal wound with gracilis muscle flaps following abdom-inoperineal resection and intraoperative radiation therapy for recu-rrent carcinoma of the rectum[J]. Ann Surg Oncol, 1999, 6(1):33-37.
  17. 17. 王波, 王志國, 連海云, 等. 腰臀筋膜皮瓣修復骶部褥瘡的臨床應用[J]. 實用骨科雜志, 2003, 9(6):550.
  18. 18. Christensen HK, Nerstrøm P, Tei T, et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer[J]. Dis Colon Rectum, 2011, 54(6):711-717.
  19. 19. 朱麗莉, 卜麗文. 股薄肌皮瓣修復直腸癌腹會陰切除術后會陰缺損的護理[J]. 上海護理, 2005, 5(6):1-3.
  20. 20. Han JG, Wang ZJ, Gao ZG, et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection[J]. Dis Colon Rectum, 2010, 53(2):219-223.
  21. 21. , 58(2):176-183.