乙状结肠造口改行结肠代膀胱在直肠癌术后局部复发全盆腔脏器切除术中的应用  

Application of modified sigmoid conduit in total pelvic exenteration for rectal carcinoma patient with pelvic recurrence

作　　者：丁召[1] 张秋雷[1] 江从庆[1] 刘韦成[1] 吴云华[1] 郑科炎[1] 秦前波[1] 钱群[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科,武汉430071

出　　处：《腹部外科》2014年第4期276-278,共3页Journal of Abdominal Surgery

摘　　要：目的观察直肠癌术后局部复发行全盆腔脏器切除术中将原乙状结肠造口改行结肠代膀胱的临床疗效。方法回顾性分析自2009--2013年因腹会阴联合切除术后盆腔局部复发而行全盆腔脏器切除的12例的临床资料。该组患者均截取10～12cm长的原有乙状结肠造口肠管改行结肠代膀胱，近端行横结肠襻式造口。术后1年为临床疗效观察终点。结果该组行全盆腔脏器切除术平均手术时间为（348±47）min，术中平均失血量约为（630±110）ml。3例患者术后近期发生结肠代膀胱相关并发症，其中出血2例，黏膜部分坏死1例。患者术后1年生存率为66．7oA（8／12）。术后1年内随访超声检查均未发现输尿管扩张、肾积水。结论应用原有乙状结肠造口改行结肠代膀胱的方法简单、手术时间短、泌尿造口相关并发症少，适应于选择性的直肠癌术后复发行全盆腔脏器切除的患者。Objective To explore the function and complications of modified sigmoid conduit in total pelvic exenteration （TPE） for rectal carcinoma patient with pelvic recurrences. Methods Retro spective analyses were conducted for 12 cases undergoing TPE for local recurrence after Miles opera- tion from 2009 to 2013. The endpoint was set at 1 year after operation. Results Among them, the mean operative duration was 308 47 min and estimated blood loss 430 110 ml. Short-term complications including sigmoid conduit bleeding （n = 2） and partial mucosa necrosis （n = 1）. Post-operative 1- year survival rate was 66. 7% （8/12）. During 1-year follow-up, no ureteral hydronephrosis or dilation was found on ultrasonography. Conclusions Modified sigmoid conduit is simple and practicable for neobladder construction during TPE.

关 键 词：直肠肿瘤 复发 

分 类 号：R657.1[医药卫生—外科学]