宫颈癌根治性放疗后复发并肠梗阻高危体质患者的手术理念及技巧

Surgical concept and techniques of recurrent cervical cancer patients accompanied with high risk of intestinal obstruction after radical radiotherapy

目的探讨宫颈癌根治性放疗后复发并肠梗阻高危体质患者肠梗阻的治疗方法。方法回顾性分析2012年5月至2018年5月就诊于河南省肿瘤医院、行手术治疗的10例宫颈癌根治性放疗后肿瘤复发、伴高危虚弱体质肠梗阻患者的临床资料,分析患者术前放疗剂量、体质、梗阻情况、手术时间、手术出血量、术后患者消化道通畅效果和饮食情况。10例宫颈癌患者均为根治性放疗后肿瘤复发合并肠梗阻,自立行走活动障碍。结果10例患者的中位禁食时间为21 d,中位体重为35.5 kg,中位体质指数为13.3 kg/m^2,中位血红蛋白值为67 g/L,中位血小板值为44×10^9/L。10例患者均行肠造口,中位手术时间为6.0 min,中位出血量为5.0 ml。术后10例患者造口均排便,术后1 d进流食,术后5 d均能自立行走。结论对于宫颈癌根治性放疗后复发的高危体质肠梗阻患者,尽管体质极度虚弱,如果治疗策略及手术方法得当,部分患者仍有机会解除肠梗阻。

Objective To explore the method of relieving intestinal obstruction in patients with recurrent cervical cancer accompanied with intestinal obstruction after radical radiotherapy.Methods The data of 10 recurrent cervical cancer patients accompanied with high risk weak constitution and intestinal obstruction after radical radiotherapy from May 2012 to May 2018 were retrospectively analyzed,including preoperative radiotherapy dose,physique and obstruction status,operation time,operation blood loss,postoperative digestive tract patency and diet.All of the 10 patients with cervical cancer recurrence accompanied with intestinal obstruction and disturbance of independent walking after radical radiotherapy.Results The median fasting time of the 10 patients was 21 days,the median weight was 35.5 kg,the median body mass index(BMI)was 13.3 kg/m^2,the median value of hemoglobin was 67 g/L,and the median value of platelet was 44×10^9/L.All of the patients underwent enterostomy.the median operation time was 6.0 min and the median amount of bleeding was 5.0 ml.All of the patients defecated after operation,fed on the first day after operation,and were able to walk on their own 5 days after operation.Conclusions Although the cervical cancer patients with recurrent intestinal obstruction after radical radiotherapy are extremely weak,some patients still have the opportunity to relieve intestinal obstruction if the treatment strategy and surgical method are appropriate.