带蒂大网膜瓣联合基底膜生物补片重建盆底在合并骶尾骨的盆腔脏器联合切除术中的临床应用  

Clinical application of reconstruction of pelvic floor with pedunculated omentum flap combined with basement membrane biological products in pelvic exenteration with sacrococcygeal bone

作　　者：陈国良 王虞鹭 谢奇峰 苏宁 王治国 邵国益 张剑 Chen Guoliang;Wang Yulu;Xie Qifeng;Su Ning;Wang Zhiguo;Shao Guoyi;Zhang Jian(Department of Colorectal Surgery,the Second Affiliated Hospital of Naval Medical University,Shanghai200003,China;Department of General Surgery,Jiangyin People's Hospital,Jiangyin214400,China)

机构地区：[1]海军军医大学第二附属医院肛肠外科,上海200003 [2]南通大学附属江阴医院江阴市人民医院城中普通外科一科,江阴214400

出　　处：《中华胃肠外科杂志》2024年第11期1162-1167,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国防科技卓越青年科学基金(2019-JCJQ-ZQ-002);军队高层次科技创新人才工程学科拔尖人才计划[第(2020)BJ06038];上海市东方学者(SHSDFXZZJ)。

摘　　要：目的分享带蒂大网膜瓣联合基底膜生物补片重建盆底技术,在局部晚期或局部复发直肠癌合并骶尾骨的盆腔脏器联合切除术(PE)中的应用经验,并探讨该技术的可行性、安全性及近期疗效。方法针对合并骶尾骨切除的PE手术患者采用基底膜生物补片联合带蒂大网膜瓣重建盆底,隔离腹盆腔,主要操作为将保留双血管弓的大网膜游离牵拉至盆底,覆盖盆底创面,再将生物补片封闭覆盖后腹膜缺损-骨盆入口,使用2-0或更粗的可吸收缝线将补片与自Treitz韧带起后腹膜、侧腹膜缺损连续缝合。结果通过中国直肠癌盆腔脏器联合切除病例数据库收集海军军医大学第二附属医院肛肠外科于2022年7月1日至2023年6月30日期间收治的局部晚期或局部复发直肠癌无盆腔外转移、或仅有寡转移而接受盆腔脏器合并骶尾骨切除术的20例患者临床数据进行分析,其中10例采用单纯基底膜生物补片重建盆底(单纯补片组),10例采用带蒂大网膜瓣联合基底膜生物补片重建盆底(网膜瓣联合补片组)。两组患者基线资料和术中情况的差异均无统计学意义(均P>0.05);网膜瓣联合补片组引流管拔除时间为26.7(19~42)d,短于单纯补片组的40.4(24~56)d(U=4.125,P=0.001);网膜瓣联合补片组空盆腔痊愈时间为29.4(23~43)d,短于单纯补片组的42.2(27~58)d(U=4.043,P=0.001);差异均具有统计学意义。网膜瓣联合补片组≥Ⅲ级的术后并发症发生率为1/10,低于单纯补片组6/10,两组差异无统计学意义(P=0.057)。全组中位随访9.5(3~15)个月,20例均存活,未见手术部位肿瘤复发。结论在局部晚期或局部复发直肠癌行合并骶尾骨的PE手术中,与单纯基底膜生物补片重建盆底相比较,带蒂大网膜瓣联合基底膜生物补片重建盆底、隔离腹盆腔安全可行。Objective To introduce the experience of reconstructing the pelvic floor with a pedicled large omental flap combined with a basement membrane biological mesh in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer combined with sacrococcygeal resection,and to discuss the feasibility,safety,and near-term therapeutic efficacy of this technique.Methods For patients with sacrococcygeal resection of combined pelvic organs,a basement membrane mesh was used to rebuild the pelvic floor with a pedicled greater omentum flap to isolate the abdominopelvic cavity.The main operation was to pull the greater omentum,which preserved the double vascular arches,to the pelvic floor to cover the pelvic floor,and then the mesh was used to cover the posterior peritoneal defect and pelvic inlet with absorbable sutures of 2-0 or thicker.Results In this study,a retrospective cohort study was used to collect clinical data through the China Rectal Cancer Combined Pelvic Organs Resections Case Database.Twenty patients with locally advanced or locally recurrent rectal cancer without extra-pelvic metastasis or only oligometastases underwent combined pelvic organ and sacrococcygeal resection in the Department of Anal and Intestinal Surgery of the Second Affiliated Hospital of the Naval Military Medical University during the period of July 1,2022,to June 30,2023,and 10 patients underwent simple basement membrane resection with a simple basement membrane.Among them,the pelvic floor were reconstructed by basement membrane mesh alone in 10 cases(mesh only group),and 10 cases were reconstructed the pelvic floor by pedicled large omental flap combined with basement membrane mesh(omental flap-combined mesh group).The recent outcomes of the two groups of patients were studied comparatively.Comparison of baseline data and intraoperative conditions between the two groups showed no statistically significant differences(all P>0.05);the drain removal time in the omental flap-combined mesh group was 26.7(19-42)days,which wa

关 键 词：盆腔脏器切除 合并骶尾骨切除 空盆腔综合征 盆底重建 基底膜生物补片 带蒂大网膜瓣 

分 类 号：R735.37[医药卫生—肿瘤]