带蒂腹直肌肌瓣用于盆腔廓清术盆底重建的初步探讨  

Primary analysis of pedicle rectus abdominis muscular flap for pelvic floor reconstruction after pelvic exenteration

作　　者：李广学[1] 杨锴[1] 刘岩[1] 王志启[2] 邓浩[2] 臧荟然 王偲[1] 王建六[2] LI Guangxue;YANG Kai;LIU Yan;WANG Zhiqi;DENG Hao;ZANG Huiran;WANG Cai;WANG Jianliu(Department of Plastic and Reconsiructive Surgery,Peking University People’s Hospital,Beijing 100044,China;不详)

机构地区：[1]北京大学人民医院整形美容科,100044 [2]北京大学人民医院妇产科,100044

出　　处：《中国妇产科临床杂志》2022年第2期139-142,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：北京大学人民医院研究与发展基金资助项目(RDY2020-04,RDG2021-04)。

摘　　要：目的探讨带蒂腹直肌肌瓣用于盆腔廓清术盆底修复重建的可行性及有效性。方法收集2019年10月至2021年6月北京大学人民医院因妇科恶性肿瘤行盆腔廓清术后带蒂腹直肌肌瓣盆底修复重建8例患者的临床资料,进行回顾性分析。结果8例患者的年龄39~68岁(中位年龄57.5岁),其中2例采取部分带蒂腹直肌肌瓣转移盆底重建术,6例采取全长带蒂腹直肌盆底重建术。重建时间为60~90 min。术后1例出现输尿管瘘,行再次手术修复;术后2例出现术后阴道分泌物增多,抗感染治疗1个月后好转;2例出现腹壁切口感染,清创后伤口愈合。术后随访2~13个月(中位时间6.5个月),1例于术后4个月因癌症复发死亡,7例存活。8例患者无肠梗阻、肠穿孔、肠瘘等晚期并发症及早期及晚期肌瓣相关的并发症。结论带蒂腹直肌肌瓣移植是一种安全有效、简单快速的自体组织盆底重建方式。Objective To explore the feasibility and short-term effectiveness of pelvic floor reconstruction by pedicle rectus abdominis muscular flap after pelvic exenteration.Methods Eight patients with pelvic floor reconstruction by pedicle rectus abdominis muscular flap after pelvic exenteration between October 2019 and June 2021 were reviewed and analysed retrospectively.Results The patients were from 39 to 68 years old(median age 57.5),2 pelvic floor reconstructions with partial pedicle rectus abdominis muscular flap,6 pelvic floor reconstructions with whole pedicle rectus abdominis muscular flap,the reconstruction time were 60 to 90 minutes.1 case had ureteral fistula and underwent further surgical repair.2 cases complained of increased vaginal discharge,they were all improved with anti infection therapy after 1 month and without any further surgical intervention.Abdominal incision infection occurred in 2 cases,and the wound healed after debridement.The patients were followed up 2 to 13 months(median 6.5 months),1 case died of tumor recurrece 4 months after surgery,and 7 patients survived.There was no late complication,such as bowel obstruction,bowel perforation and fistulas.There was no early and late muscular flap related complications.Conclusion The pedicled rectus abdominis muscular flap is a safe,effective,simple and rapid method for pelvic floor reconstruction after pelvic exenteration.

关 键 词：盆腔廓清术 盆底重建 肌瓣 空盆综合征 

分 类 号：R713[医药卫生—妇产科学]