低位直肠癌行后盆腔脏器切除联合远端阴道及会阴体切除术后会阴重建的方式及体会  

Perineal and Vaginal Reconstruction after Posterior Exenteration with Resection of Distal Vagina and Perineal Body:Cases Report and Literatures Review

作　　者：王自强[1] 张元川[1] 邓祥兵[1] 王默进[1] 孟文建[1] 魏明天[1] 金成武[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041

出　　处：《中国普外基础与临床杂志》2013年第11期1228-1233,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结低位直肠癌累及远端阴道及会阴体时行后盆腔脏器切除及远端阴道及会阴体切除后会阴重建的各种方法的应用体会。方法总结我院2008年10月至2013年9月期间收治的10例直肠癌联合远端阴道及会阴体切除后的重建方式及围手术期的临床资料。结果 10例患者中2例行子宫及阴道全切除,3例行子宫及阴道后壁切除,5例行单纯远端阴道和(或)会阴体切除。分别采用大网膜填塞(4例)、阴道前壁翻转缝合(3例)、子宫后倾(2例)、带蒂乙状结肠(2例)重建盆腔及阴道会阴缺损。1例患者盆腔严重感染,2例患者会阴部切口感染或裂开。结论女性低位直肠癌患者行后盆腔联合脏器切除后切口相关并发症率极高,可根据盆腔、会阴及阴道的缺损情况选用子宫或网膜填塞盆腔、带蒂肠段或肌皮瓣、生物补片等方法进行一期修复缺损,采用腹直肌或臀大肌肌皮瓣修复会阴巨大缺损成为目前主流的修复方式,但国内该技术报道极少,值得积极开展应用。Objective To summarize the application of different types ofperineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion, and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method extended surgery with distal vagina and perineal body resection The clinical data of 10 rectal cancer patients underwent accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications, in which included 1 patient with pelvic sepsis who underwent reoperation for drainage, 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction, omental flap, pedicled sigmoid flap, overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.

关 键 词：直肠癌 后盆腔脏器切除 修复外科 术后并发症 

分 类 号：R735.37[医药卫生—肿瘤]