摘要
目的探讨盆腔脏器联合切除术治疗原发及复发盆腔脏器恶性肿瘤的安全性和有效性。
方法回顾性分析2010年4月至2014年12月接受盆腔脏器联合切除术(PE)治疗的20例盆腔脏器恶性肿瘤患者的临床资料。男7例,女13例。年龄35~87岁,平均65岁。泌尿系统肿瘤13例,其中原发肿瘤7例,复发肿瘤6例;4例术前行化疗。非泌尿系统肿瘤7例,其中原发肿瘤2例,复发肿瘤5例;术前行化疗、放疗各3例。20例患者中10例接受前盆腔脏器联合切除术(APE),其中行回肠膀胱术和输尿管皮肤造口术各5例;10例接受全盆腔脏器联合切除术(TPE),其中行回肠膀胱术6例,输尿管皮肤造口术4例。APE组中原发肿瘤6例,TPE组中原发肿瘤3例。手术采用全麻,取腹正中切口。清扫两侧髂血管旁淋巴结,游离出双侧输尿管至末端膨大处,分离膀胱腹膜间隙,男性患者切断并结扎两侧输精管,于膀胱后壁与直肠前壁间将精囊游离、切断。再沿狄氏筋膜游离至前列腺尖部。切断膀胱侧韧带、前列腺侧韧带和耻骨前列腺韧带,缝扎阴茎背深静脉并切断,游离并切断前列腺尖部尿道。女性患者需游离子宫体及后壁,切断双侧子宫主韧带和圆韧带,游离子宫后壁直达阴道后壁。直肠切除采取腹会阴联合切除术,同时于左侧腹壁行乙状结肠造口。
结果APE组和TPE组的平均手术时间分别为3.8 h和5.2 h,中位失血量分别为300 ml(80~2 500)ml和400 ml(50~6 000)ml,两组比较差异无统计学意义(P=0.173,P=0.909)。20例患者中位住院时间17.9 d(7~47)d。中位随访时间12.5个月。APE组2年生存率为55.6%,TPE组为45.0%,差异无统计学意义(P=0.642)。泌尿系统肿瘤组与非泌尿系统肿瘤组的中位生存时间分别为28个月和13个月,差异无统计学意义(P=0.538)。泌尿系统肿瘤组发生胃肠道并发症和切口并发症各1例,输血6例;非泌尿系统肿瘤组发生胃肠道并发症和切口并发症各2例、尿流改道并发症1例,输血2例。
结论PE治疗局部晚期原发和复发盆腔恶性肿瘤是安全的,即使对复发肿瘤患者行PE治疗,依然可以使患者获得相对满意的生存结果。
ObjectiveThe objectives of present study is to investigate the safety and efficacy of pelvic exenteration (PE) for the treatment of pelvic malignancies in urology department.
MethodsFrom April 2010 to December 2014, 20 patients with primary or recurrent pelvic malignancy accepted anterior pelvic exenteration (APE) or total pelvic exenteration(TPE) surgery, including 7 males and 13 females, ranged from 35 to 87 years old with an average of 65 years old. Ten case accepted APE and 10 for TPE. The ilium conduit was done in 5 cases for APE and 6 cases for TPE as urinary diversion, cutaneous ureterostomy was done in 5 cases for APE and 4 cases for TPE as urinary diversion. There were 6 cases primary tumor in APE group and 3 primary tumors in TPE. All of the patients had 13 cases of the urinary tract tumor group, and none of the urinary tract tumor group in 7 cases. There were 4 cases received preoperative chemotherapy in the urinary tract tumor group. No case received preoperative radiotherapy. 3 cases received preoperative chemotherapy in none of the urinary tract tumor group, 3 cased received preoperative radiotherapy. After induction of general anesthesia using a laryngeal mask for airway management. All patients took the abdominal incision, then dissected lymph nodes on both sides of the iliac vessels, freed bilateral ureters to the end of the swollen bladder, separated the peritoneal space.The bilateral vas deferens was cutted and ligated, then isolated and ligated the seminal vesicles between the posterior wall of the bladder and the anterior wall of the rectum.Lateral ligaments of bladder was cuted, then cuted ligament of prostate and puboprostatic ligament, sutured and cut deep vein of penis. Urethra of apex prostate was freed and cuted. Female patients needed to free the uterus and the posterior wall, cut the cardinal ligament and round ligament of uterus, isolate the posterior wall of the uterus to the posterior vaginal wall. Rectal resection adopted Miles operation.And sigmoid colostomy was performed on the left side of the abdominal wall. The perioperative characters, pathological results and patients′ survival data were collected and analyzed.
ResultsThe average operation time for APE was 3.8 hours and 5.2 hours for TPE (P=0.173). Median length of hospital stay was 17.9 (7-47) days. The median blood loss was 300ml (80-2 500 ml) for APE and 400ml (50-6 000 ml) for TPE (P=0.909). The median follow-up time was 12.5 months (1-41months). The estimated 2-year survival rate for APE was 55.6% and 45.0% for TPE (P=0.642). Urinary system tumors group and non urinary system tumors group were analyzed and compared, The median survival time was 28 months and 13 months (P=0.538) in the two groups.The incidence of gastrointestinal complications of urinary system tumors and non-urinary system tumors was 7.7% and 28.6%, incision complications was 7.7% and 28.6%. Complications of urinary diversion only occurred in the non urologic tumor group, the incidence was 14.3%. The incidence of transfusion in two groups was 46.2% and 28.6%.
ConclusionsPelvic exenteration (APE and TPE) could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy. Even for the recurrent malignancies, the survival results of the patients were satisfactory.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第1期29-33,共5页
Chinese Journal of Urology
基金
国家自然科学基金资助项目(81272829)