局部晚期/复发直肠癌行全盆腔脏器切除术的焦点和挑战  

Total pelvic exenteration for locally advanced/recurrent rectal cancer:focuses and challenges

作　　者：陶禹 张剑 TAO Yu;ZHANG Jian(Department of Colorectal Surgery,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China)

机构地区：[1]海军军医大学(第二军医大学)第二附属医院肛肠外科,上海200003

出　　处：《海军军医大学学报》2023年第2期133-142,共10页Academic Journal of Naval Medical University

基　　金：国防科技卓越青年科学基金(2019-JCJQ-ZQ-002)。

摘　　要：全盆腔脏器切除术(TPE)已成为治疗局部晚期/复发直肠癌的重要方式。随着手术技术的进步、围手术期管理水平的提高及多学科诊疗模式的开展,TPE在正确解剖入路的引导下提高了手术根治性、长期生存率并降低了再复发率。骨性骨盆(尤其是高位骶骨)和坐骨神经的切除有助于进一步提高R0切除率。由于切除了更多的盆腔器官和组织,TPE后空盆腔综合征发生率较高、处理棘手,生物补片和肌皮瓣重建盆底缺损可能有助于减少术后并发症。泌尿系统重建和血管重建是TPE手术的难点,选择合适的重建方式尤为重要。Total pelvic exenteration(TPE)has become an important modality for the treatment of locally advanced/recurrent rectal cancer.With the advancement of surgical techniques,the improvement of perioperative management,and the development of multidisciplinary treatment,the radicality and long-term survival of TPE were improved under the guidance of accurate anatomical levels,and the recurrence rate was decreased.The resection of the pelvis(especially the high sacrum)and the sciatic nerve further improved the R0 resection rate.Due to the removal of more pelvic organs and tissue,the incidence of empty-pelvic syndrome after TPE was high and difficult to manage,and the reconstruction of pelvic floor defect with biological patches or myocutaneous flaps might help to reduce postoperative complications.Urinary system reconstruction and vascular reconstruction were difficult for TPE,and it was particularly important to select the appropriate reconstruction method.

关 键 词：全盆腔脏器切除术 直肠肿瘤 局部晚期直肠癌 局部复发直肠癌 修复外科手术 

分 类 号：R735.37[医药卫生—肿瘤]