8例改良乙状结肠双筒湿造口用于盆腔脏器联合切除术后重建尿液—大便流出通道的疗效分析并文献复习

Modified double-barreled wet colostomy on the reconstruction of urinary and fecal diversion for patients with pelvic exenteration: experience from 8 cases and literature review

目的 探讨改良乙状结肠双筒湿造口用于盆腔脏器联合切除术后重建尿液—大便流出通道的应用效果。方法 回顾性分析2021年7月至2022年9月由笔者团队施行盆腔脏器联合切除术后采用改良乙状结肠双筒湿造口重建尿液—大便流出通道的8例患者的临床资料。其中,男性6例,女性2例,中位年龄为55.5(52.3,56.8)岁;3例为复发性直肠癌,2例为肛瘘癌变侵犯盆壁,1例为局部晚期直肠癌,1例为骶前恶性肿瘤,1例为局部晚期前列腺癌,所有患者术前均经病理确诊,接受盆腔脏器联合切除术(2例加做全尿道切除术)。记录术后恢复情况及随访期间临床结局。结果 所有患者均一期出院,术后7~10 d拔除输尿管内引流管,术后中位住院时间为13.0 (12.3,15.5) d,均无严重的手术相关并发症。术后中位随访时间为9.0 (5.5,12.8)个月,患者肾功能指标水平均在正常值参考范围,未出现静脉应用抗生素处理尿源性感染的情况;1例复发性直肠癌患者出现造口回缩,因腹主动脉瘤破裂死亡;1例肛瘘癌变患者出现盆腔癌灶复发;其余患者未出现造口相关并发症,疾病无复发。结论 在对患者进行谨慎筛选的前提下,改良乙状结肠双筒湿造口可作为盆腔脏器联合切除术后重建尿液—大便流出通道的术式选择。

Objectives To explore the effectiveness of modified double-barreled wet colostomy on the reconstruction of urinary and fecal diversion for patients with pelvic exenteration. Methods This was a retrospective analysis of 8 patients with modified double-barreled wet colostomy on the reconstruction of urinary and fecal diversion, who were hospitalized and underwent pelvic exenteration from July 2021 to September 2022. Of the 8 patients, 6 were male and 2 were female with a median age of 55.5(52.3, 56.8)years, including 3 patients with recurrent rectal cancer, 2 patients with cancer of the peri-anal fistula, 1 patient with locally advanced rectal cancer, 1 patient with presacral cancer and 1 patient with locally advanced prostate cancer. All patients were eligible for pelvic exenteration, and 2 cases were also eligible for urethrectomy. Postoperative recovery and clinical outcomes were recorded during follow-up. Results All patients were discharged uneventfully. The ureter stents were removed within 7 to 10 days postoperatively and the median postoperative hospitalization was 13.0(12.3, 15.5) days. No serve surgical complication was reported. With a median follow-up of 9.0(5.5, 12.8) months, renal function imaging showed good effects and no urinary tract-related infection requiring intravenous antibiotics. One case with recurrent rectal cancer had stoma contraction and died of abdominal aortic aneurysm rupture, and 1 case with cancer of the peri-anal fistula had local recurrence. No stoma-related complication or recurrence occurred in the other cases. Conclusion On the premise of careful screening of patients, modified double-barreled wet colostomy could be a reasonable procedure for the selected cases on the reconstruction of urinary and fecal diversion for patients with pelvic exenteration.