盆腔肿瘤术中盆底腹膜重建困难时骶前残腔的处理对策

The countermeasures of the presacral residual cavity occurrence during the difficulties of the pelvic peritoneum reconstruction of the pelvic cancer surgery

目的:探讨盆腔肿瘤术中盆底腹膜重建困难时骶前残腔的处理。方法:回顾2005年1月至2012年6月信阳市中心医院普外科收治的45例盆腔肿瘤患者临床资料,45例患者行肿瘤切除后由于盆底腹膜无法封闭,采用大网膜盆底铺垫或盲肠/子宫填充或肛门后弧形切开骶前填塞纱垫,从而消除骶前残腔。结果:本组患者术后无1例出现由于肠管坠入盆底造成肠梗阻的发生;1例出现尿瘘,1例出现会阴部感染,2例出现腹腔积液,经治疗后均痊愈出院。本组患者无1例死亡。结论:采用大网膜盆底铺垫或盲肠/子宫填充或肛门后弧形切开骶前填塞纱垫的方法,消除了骶前残腔,是预防肠管坠入盆底形成肠梗阻的有效方法,提高了手术的安全性,值得在临床上推广。

Objective： Explore the handling of the residual cavity in the presacral when the difficulties of the pelvic peritoneum reconstruction occurred during the pelvic cancer surgery.Methods： Retrospectively analyse the clinical data of 45 patients with pelvic cancer from Jan 2005 to Jun 2006 of Xinyang Central Hospital.Because pelvic peritoneum could not be closed,we have adopted the greater omentum pelvic floor bedding or filling of the cecum/uterus or anus curved cut presacral filling yarn pad,thus eliminating the residual cavity in the anterior sacral.Results： none of patients occurred intestinal obstruction caused by intestinal fall in pelvic floor;1 occurred perineal infection,which was discharged by Bath;Two occurred ascites,1 through CT-guided puncture and drainage,1 was discharged after conservative treatment.No death.Conclusion： Use of foreshadowing of the greater omentum pelvic floor or the cecum/uterus arc cut presacral filling yarn pad fill or anus,to eliminate the residual cavity in the anterior sacral,the prevention of bowel to fall in the pelvic floor to the formation of intestinal obstruction improve surgicalsecurity,it is worthy in clinical practice.