采用臀大肌皮瓣进行盆底重建治疗盆腔脏器联合切除术后会阴伤口愈合失败患者的疗效分析  

Pelvic floor reconstruction with gluteus maximus myocutaneous flap in the treatment of perineal wound healing failure after pelvic exenteration

作　　者：陶禹 王虞鹭 朱鴷 王治国 苏宁 张剑 Tao Yu;Wang Yulu;Zhu Lie;Wang Zhiguo;Su Ning;Zhang Jian(Department of Colorectal Surgery,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China;Department of Plastic Surgery,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院(上海长征医院)肛肠外科,上海200003 [2]海军军医大学第二附属医院(上海长征医院)整形外科,上海200003

出　　处：《中华胃肠外科杂志》2025年第1期81-85,共5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：目的探讨针对盆腔脏器联合切除术(PE)术后会阴伤口愈合失败的患者,二期手术采用臀大肌皮瓣行盆底重建的应用价值。方法采用描述性病例系列研究方法。收集2022年1月至2023年1月海军军医大学第二附属医院(上海长征医院)肛肠外科收治的24例行PE术治疗且术后会阴伤口长期不愈合的局部进展期(LARC)或复发(LRRC)直肠癌患者的临床资料。臀大肌皮瓣重建手术具体操作方法如下:清理会阴伤口坏死组织并反复冲洗,切开并分离臀大肌至臀上动脉及臀下动脉,保留中间部分肌肉蒂,于内侧缘分离部分皮肤及肌肉,去除部分表皮,将皮瓣内侧缘肌肉及皮下组织固定于创缘内侧,于创腔上下方及右侧肌间隙分别置负压吸引管,缝合皮下肌肉及脂肪层,间段缝合皮肤,创面外置负压吸引装置。术后患者需保持俯卧位,引流管至少放置7 d,24 h引流量<30 ml可拔除引流管。观察本组患者会阴伤口愈合情况和臀大肌皮瓣相关并发症。结果24例患者重建手术中位时间为180(150~230)min,术中中位出血量为100(30~200)ml。91.7%(22/24)患者术后30 d内会阴伤口成功愈合。术后随访6个月,未发生皮瓣全部或部分坏死。臀大肌皮瓣相关并发症的发生率为8.3%(2/24),1例患者发生皮瓣感染及窦道,1例患者发生皮瓣窦道,均局部麻醉下行清创术后愈合。结论对于PE术后会阴伤口愈合不良的LARC或LRRC患者,二期手术采用臀大肌皮瓣行盆底重建安全可行,能够顺利闭合会阴伤口,并且术后皮瓣相关并发症的发生率较低。Objective To investigate the value of pelvic floor reconstruction with gluteus maximus myocutaneous flap in second-stage surgery for patients with failed perineal wound healing after pelvic exenteration(PE).MethodsThis was a descriptive case series study.The clinical data of 24 patients with locally advanced(LARC)or recurrent(LRRC)rectal cancer who underwent PE and had long-term nonunion of postoperative perineal wounds were collected from the department of colorectal surgery of the Second Affiliated Hospital of Navy Medical University(Shanghai Changzheng Hospital)from January 2022 to January 2023.The specific operation methods of pelvic reconstruction by gluteus maximus myocutaneous flap are as follows:the necrotic tissue of the perineal wound was debrided and rinsed repeatedly,the gluteus maximus muscle was cut and separated from the gluteus superior and inferior arteries,the middle muscle pedicle was retained,part of the skin and muscle were separated from the medial margin,part of the epidermis was removed,the muscle and subcutaneous tissue at the medial margin of the flap were fixed to the medial edge of the wound,negative pressure suction tubes were placed above and below the wound cavity and in the muscle space on the right side,and the subcutaneous muscle and fat layer were sutured.The skin was sutured intersegmentally,and a negative pressure suction device was placed on the wound surface.After surgery,the patient should remain prone,and the drainage tube should be placed for at least 7 days.The drainage tube can be removed after 24-hour drainage is less than 30 ml.Perineal wound healing and complications related to gluteal major myocutaneous flap were observed.ResultThe median reconstruction time of 24 patients was 180(150~230)minutes,and the median intraoperative blood loss was 100(30~200)ml.91.7%(22/24)patients had successful healing of perineal wound within 30 d after operation.After a follow-up of 6 months,no complete or partial flap necrosis occurred.The incidence of complications related to gluteus

关 键 词：盆腔联合脏器切除术 臀大肌皮瓣 盆底重建 空盆腔综合征 

分 类 号：R657.1[医药卫生—外科学]