20例宫颈癌根治性放疗后复发患者行全盆腔脏器切除保肛治疗的效果分析  

Retrospective analysis of curative effect of total pelvic organ resection and anal preservation in 20 patients with recurrence of cervical cancer after radical radiotherapy

作　　者：王刚成 高重庆 刘英俊 韩广森 王有财 张国强 丁亮亮 李斌[2] 王葆春[2] 常顺伍[2] Wang Gangcheng;Gao Chongqing;Liu Yingjun;Han Guangsen;Wang Youcai;Zhang Guoqiang;Ding Liangliang;Li Bin;Wang Baochun;Chang Shunwu(Department of General Surgery,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of General Surgery,Hainan People's Hospital,Haikou 570100,China)

机构地区：[1]郑州大学附属肿瘤医院普外科,450008 [2]海南省人民医院普外科,海口570100

出　　处：《中华肿瘤杂志》2020年第3期242-246,共5页Chinese Journal of Oncology

基　　金：2018年海南省重点科技项目(ZDYF2018112)。

摘　　要：目的探讨宫颈癌根治性放疗后中心型复发行全盆腔脏器切除后保肛治疗患者的手术方式和疗效。方法回顾性分析2013年1月至2017年12月在郑州大学附属肿瘤医院和海南省人民医院行全盆腔脏器切除保肛治疗的20例宫颈癌根治性放疗后中心型复发患者的临床资料,评价手术时间、术中出血量、患者的住院时间、肛门功能和术后并发症等指标。结果20例宫颈癌根治性放疗后复发患者全盆腔脏器切除后行保肛术的中位手术时间为135.2 min,术中中位出血量为680 ml,中位住院时间为16.5 d。其中18例患者术后愈合良好,术后6个月肛门功能逐渐恢复正常。1例患者出现外置结肠与肛门周围粘连愈合不全,1例患者出现骶前感染。20例患者的术后病理均证实为复发,其中鳞癌11例,腺癌7例,腺鳞癌2例。结论对于宫颈癌根治性放疗后中心型复发患者行全盆腔脏器切除后保肛是安全可靠的,且术后肛门功能良好,保肛可明显提高患者的术后生活质量,是一种值得推广的手术方式。Objective To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer.Methods Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People′s Hospital from January 2013 to December 2017 were retrospectively analyzed.The operative time,intraoperative blood loss,length of stay,postoperative anal function and postoperative complications were evaluated.Results The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min,the median intraoperative blood loss was 680 ml,and the median hospitalization time was 16.5 days.Among them,18 patients had good postoperative healing,and the anal function gradually returned to normal within 6 months after surgery,defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus.One patient presented with pre-sacral infection.Postoperative pathology confirmed the recurrences in 20 patients,of which 11 cases were squamous cell carcinoma,7 cases were adenocarcinoma,2 cases were adenosquamous cell carcinoma.Conclusions It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy.The anus function is good enough to improve the postoperative life quality of patients significantly.

关 键 词：宫颈肿瘤 复发 外科手术 全盆腔脏器切除 

分 类 号：R737[医药卫生—肿瘤]