完全肿瘤细胞减灭术加全盆腔切除加腹腔热灌注化疗在腹膜癌合并盆腔肿瘤中的应用  

Radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy plus total pelvic exenteration in patient with peritoneal metastasis and advanced pelvic desease

作　　者：Pedro Barrios Oriol Crusellas Montse Martin Isabel Ramos 姬忠贺(翻译) 李雁(审校) Pedro Barrios;Oriol Crusellas;Montse Martin;Isabel Ramos(Unidad de Cirugia Oncologica Peritoneal,Complejo Hospitalario Moises Broggi.Sant Joan Despi,Barcelona,Spain;Unidad de Epidemiologia,Complejo Hospitalario Moises Broggi.Sant Joan Despi,Barcelona,Spain)

机构地区：[1]圣琼德斯帕Moises Broggi综合医院腹膜肿瘤中心 [2]圣琼德斯帕Moises Broggi综合医院流行病学中心 [3]不详

出　　处：《中国肿瘤临床》2022年第24期1273-1276,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:肿瘤细胞减灭术(cytoreductive surgery,CRS)+全盆腔切除术(total pelvic exenteraction,TPE)+腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)整合治疗策略,是目前唯一可能治愈腹膜癌合并晚期盆腔肿瘤的疗法。本研究探讨CRS+TPE+HIPEC适应证、手术方式和技巧,尤其是避免功能性造瘘的重建方法。方法:数据来源于本中心前瞻性数据库,选取2006年9月至2021年1月,共1 172例腹膜癌患者,累计接受CRS+HIPEC治疗1 314例次,其中14例接受TPE且无造瘘功能重建,纳入研究对象。结果:14例患者均通过腹膜切除术实现了腹部肿瘤细胞减灭程度(completeness of cytoreduction,CC)评分0(CC 0)切除,通过TPE实现了盆腔R0切除,且无任何形式造瘘。无消化道吻合口病发症,术后尿漏5例,其中3例无需有创修补,1例行肾造瘘术,1例二次手术修补。无术后90天内死亡。结论:CRS+HIPEC手术中,TPE非绝对禁忌。在高度专业化的腹膜癌中心,肿瘤病理学家和专业手术团队联合,可提高CRS+TPE+HIPEC整合治疗策略的安全性和有效性,促进术后恢复,提高患者生活质量。CRS+TPE+HIPEC整合治疗策略的应用仍有待进一步深入研究。Ojective: Some patients with peritoneal metastasis treated with cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) present advanced tumor in pelvis which requied a total pelvic exenteration(TPE) for completing the radicality of surgery. This study aims to present the criteria used for the indication of CRS+TPE+HIPEC and the surgical techniques and modalities and, especially, reconstructive of TPE aimed at avoiding functional stomata. Methods: The information comes from a prospective database that includes 1,172 patients with peritoneal metastases underwent 1,314 procedures of CRS+HIPEC during the period September 2006 to January2021. We identified 14 patients underwent TPE and function reconstruction without the practice of any kind of stomata. Results: In all patients, completeness of cytoreduction(CC)-0 was achieved by applying peritonectomy procedures(PP) and radial margins R0 in the TPE.There were no complications in digestive anastomosis. In 5 patients, urinary leakage was observed in the postoperative period(3 cases did not require invasive reparing measures, one patient accepted a nephrostomy, and one patient was reoperated). There were no postoperative deaths within 90 days. Conclusions: In the context of CRS+HIPEC, TPE should not be absolutly excluded. The concentration of oncological pathologists and surgical team in highly specialized centers allows to improve the efficacy and safety of the combination of CRS+TPE+HIPEC and the possibility of offering improvements in the recovery and quality of life of these patients. The CRS+TPE+HIPEC combination in patients with peritoneal metastases and advanced pelvic disease still requires further studies.

关 键 词：全盆腔切除术 消化道及泌尿道重建 CRS+HIPE 

分 类 号：R735.5[医药卫生—肿瘤] R737.33[医药卫生—临床医学]