背景与目的:在卵巢癌的手术中,将盆腔肿瘤与受累的结直肠一并切除,同时行肠吻合的改良后盆腔脏器切除术,有助于提高肿瘤细胞减灭效果,同时减小对患者生活质量的影响.本研究旨在评价晚期卵巢癌初次手术中行改良后盆腔脏器切除的可行性、安全性和疗效.方法:回顾性分析2006年1月-2010年12月我院妇瘤科在卵巢癌初次肿瘤细胞减灭术中经腹膜外整块切除子宫附件、盆腔腹膜和部分结直肠并行结肠直肠吻合的改良盆腔脏器切除50例患者临床病理资料.结果:患者平均年龄57岁(37～85岁),FIGO分期为Ⅱc期1例(2.0%)、Ⅲc期40例(80.0%)、Ⅳ期9例(18.0%).26例(52.0%)患者还进行了除大网膜切除外的1个或多个其他腹部手术,用吻合器行结肠直肠吻合30例(60.0%),手工吻合20例(40.0%),无一例行预防性肠造瘘.平均手术时间224 min(150～320 min),平均术中出血量1 268 mL(100～3 000 mL),平均输红细胞900 mL(0～2 200 mL).84.0%患者术后残余肿瘤最大径≤1 cm.88.0%患者术后病理证实肿瘤累及肠管.术后并发症发生率为26%,吻合口漏和直肠阴道瘘各1例(4.0%),术后无造瘘率达98.0%,无围手术期死亡.48例患者术后接受紫杉醇联合铂类化疗,中位生存时间33.8个月.结论:卵巢癌初次减灭术中行改良后盆腔脏器切除有助于提高盆腔内肿瘤减灭效果,行结肠直肠吻合安全可行,无须预防性回肠造瘘.%Background and purpose: In order to achieve the maximal cytoredction with less influence on the ovarian cancer patients' quality of life, en bloc resection of pelvic tumor with involved resctosigmoid and anastomosis (modified posterior pelvic exenteration) is one of the important procedures. The study aimed to evaluate the feasibility, safety and efficacy of modified posterior pelvic exenteration in primary cytoreductive surgery among patients with epithelial ovarian cancer (EOC). Methods: Medical records of 50 patients with primary EOC underwent en bloc resection of pelvic tumor with low anterior resection and anastomosis between Jan. 2006 to Dec. 2010 were reviewed. Results: The mean age was 57 years (ranged from 37 to 85). There were 1 FIGO stage II. (2.0%), 40 stage Ⅲ。 (80.0%) and 9 stage IV (18.0%) patients. Twenty-six patients (52.0%) underwent major upper abdominal procedures other than omentectomy. All anastomosis were performed by gynecologic oncologist without protective intestinal diversion, with 30 cases (60.0%) stapled and 20 cases (40.0%) hand-sewn. The mean operating time was 224 min (ranged from 150 to 320), mean estimated blood lost was 1 268 mL (ranged from 100 to 3 000) and mean red cell transfusion was 900 mL (ranged from 0 to 2 200). Of all the patients, 84.0% were left with optimal (<1 cm) residual disease. In 88.08% patients, tumor involvement of the rectum were confirmed histopathologically There were no postoperative deaths, but postoperative morbidity occurred in 26% of patients, including 1 case of anastomotic leak and 1 case of recto-vaginal fistula (4.0%) and the stoma-free rate was 98.0%. Forty-eight patients received taxol and platinum combination chemotherapy, with a median overall survival time of 33.8 months. Conclusion: Modified posterior pelvic exenteration with concomitant rectosigmoid anastomosis allows a high rate of optimal debulJdng in primary cytoreduction for EOC. It is feasible as well as safety. Prophylactic ileostomy/colostomy was not recommended.
展开▼
