盆腔脏器联合切除手术的围手术期临床结局观察研究  

Observational study on perioperative outcomes of pelvic exenteration

作　　者：袁昊 尧冰 李俊涛 朱文亮 任东林[2] 王辉[3] 马腾辉[3] 陈淑琴 吴坚坚 陶奕然 叶雷 汪中扬[1] 瞿虎[1] 马波[1] 钟文文 王德娟 邱剑光 Yuan Hao;Yao Bing;Li Juntao;Zhu Wenliang;Ren Donglin;Wang Hui;Ma Tenghui;Chen Shuqin;Wu Jianjian;Tao Yiran;Ye Lei;Wang Zhongyang;Qu Hu;Ma Bo;Zhong Wenwen;Wang Dejuan;Qiu Jianguang(Department of Urology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Pelvic Floor Diseases,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Colorectal Surgery,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Gynecology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院泌尿外科,广州510655 [2]中山大学附属第六医院盆底治疗专科,广州510655 [3]中山大学附属第六医院结直肠外科,广州510655 [4]中山大学附属第六医院妇科,广州510655

出　　处：《中华胃肠外科杂志》2023年第3期260-267,共8页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨盆腔脏器联合切除(PE)手术在局部晚期、复发盆腔恶性肿瘤及盆腔复杂瘘治疗中的手术适应证及围手术期临床结局。方法本研究为描述性病例系列研究。PE手术适应证:(1)术前经影像学及病理活检确诊为局部晚期或复发的盆腔恶性肿瘤或确诊盆腔复杂瘘;(2)非手术治疗及常规手术治疗失败、术前经多学科团队讨论以及术中探查,确认需联合切除盆腔脏器;(3)术前经过多学科团队评估可实施PE。手术禁忌证包括心肺等器官功能不全、营养状态或心理状态不佳而无法耐受手术。纳入2018年1月至2022年9月期间,符合上述标准并于中山大学附属第六医院行PE手术、围手术期临床资料完整、获得患者手术知情同意的患者临床资料,分析手术和围手术期情况、术后病理情况(手术根治性)以及术后早期并发症发生情况。结果纳入141例患者,其中43例(30.5%)为原发恶性肿瘤,61例(43.3%)为复发恶性肿瘤,28例(19.9%)为肿瘤根治后复杂瘘,9例(6.4%)为良性病致复杂瘘。其中胃肠道来源肿瘤79例(56.0%),生殖系统来源肿瘤30例(21.3%),泌尿系统来源肿瘤16例(11.3%),间叶组织来源等其他肿瘤7例(5.0%)。本组104例原发和复发恶性肿瘤患者中,15例晚期肿瘤盆会阴严重并发症患者,术前经多学科评估无法根治,计划行姑息性PE手术以缓解症状;其余89例患者经多学科评估可行根治性的PE手术。所有手术均顺利完成。73例(51.8%)行全盆腔脏器联合切除(TPE),22例(15.6%)行前盆腔脏器联合切除(APE),46例(32.6%)行后盆腔脏器联合切除(PPE)。全组中位手术时间576(453,679)min,中位术中出血量500(200,1200)ml,中位术后住院时间17.0(13.0,30.5)d,无术中死亡病例。89例评估可行根治性PE手术的患者中,64例(71.9%)达到盆腔内肿瘤根治性R0切除,23例(25.8%)R1切除,2例(2.2%)R2切除。术后85例(60.3%)出现一种及以上并发症,32例(22.7%)Clavien-DindoⅢ级Objective To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration(PE)for locally advanced,recurrent pelvic malignancies and complex pelvic fistulas.Methods This was a descriptive study.The indications for performing PE were:(1)locally advanced,recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy;(2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required;and(3)findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction,poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria,had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022,had complete perioperative clinical data,and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables,postoperative pathological findings(curative resection),and early postoperative complications were analyzed.Results Of the 141 included patients,43(30.5%)had primary malignancies,61(43.3%)recurrent malignancies,28(19.9%)complex fistulas after radical resection of malignancies,and nine(6.4%)complex fistulas caused by benign disease.There were 79 cases(56.0%)of gastrointestinal tumors,30 cases(21.3%)of reproductive tumors,16 cases(11.3%)of urinary tumors,and 7 cases(5.0%)of other tumors such mesenchymal tissue tumors.Among the 104 patients with primary and recurrent malignancies,15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team;the other 89 patients were evaluated for radical PE surgery.All surgeries were successfully completed.Total PE was performed on 73 patient

关 键 词：盆腔肿瘤 瘘 盆腔脏器联合切除手术 并发症 

分 类 号：R737[医药卫生—肿瘤]