全盆腔器官切除术治疗晚期或复发妇科恶性肿瘤16例临床分析

Clinical analysis of 16 cases of total pelvic exenteration for patients with advanced or recurrent gynecologic cancer

目的评价全盆腔器官切除术在晚期或复发妇科恶性肿瘤中的治疗价值并探讨影响预后的因素。方法回顾性分析1995年4月至2012年4月于浙江省肿瘤医院施行全盆腔器官切除术的16例晚期或复发妇科恶性肿瘤患者资料。结果中位随访时间37.5个月(3~157个月),5年总生存率51.6%。淋巴结状况显著影响患者的总生存期和无瘤生存期,其他可能影响预后的因素包括肿瘤直径、切缘状况等。最常见的并发症为盆腔积液伴感染(37.5%),最严重并发症为肠梗阻(25.0%)、尿瘘(18.8%)以及肠瘘(6.3%)。结论全盆腔器官切除术尽管并发症较多,但对于晚期或复发妇科恶性肿瘤患者来说仍是一种较安全且不明显影响生存质量的治疗方式,但术前必须严格筛选病例,排除无法切除或有远处转移的患者。

Objective To evaluate the curative value of total pelvic exenteration in the treatment of advanced or recurrent gynecologic malignant tumors and access the possible factors associated with outcome and survival.Methods We retrospectively analyzed the records of 16 patients who underwent pelvic exenteration for gynecologic malignancy between April 1995 and April 2012 in our hospital. Results The median duration of follow- up was 37.5 months（range：3~157）and the 5-year overall survival rate was 51.6%.Lymph node involvement retained a significant impact on OS and PFS.The other possible prognostic factors were tumor size,surgical margin status,etc.Infective pelvic effusion was the most common complication（37.5%）.The severest complications were ileus（25.0%）,ureteral anastomosis leak（18.8%）and intestinal anastomosis leaks（6.3%）.Conclusion Though post-surgical complications frequently occur,pelvic exenteration is still a safe therapeutic option for advanced or recurrent gynecologic malignancy with high cure rate and little influence on quality of life.But this procedure should be considered in highly selected patients with no unresectable or metastatic diseases.