盆腔脏器联合切除在盆腔放射性损伤晚期并发症中的应用

Clincal practice of pelvic exenteration for late complications of pelvic radiation injury

盆腔放射性损伤潜在可累及盆腔多个脏器,由于严重放射性损伤的“责任病灶”具有逐步进展性及不可逆性,晚期可并发盆腔多器官复杂瘘、穿孔或梗阻等多种并发症,严重影响患者的长期生存及生活质量。盆腔脏器联合切除作为一种多学科协作的“巨创”手术,彻底切除“责任病灶”,可最大程度缓解患者临床症状,并最大程度地避免今后出现放射性损伤进展,对于治疗盆腔放射性损伤晚期并发症具有潜在的应用前景。在具体的临床实践中,应倡导“盆腔放射性损伤”的整体化概念,强调多学科协作,充分评估原发肿瘤、盆腔放射性损伤及患者整体状态,遵循“损伤控制”和“扩大切除”手术原则,采用加速康复外科模式进行围手术期管理,以达到手术安全最大化,争取最大程度缓解患者临床症状,改善生活质量及长期生存预后。

Pelvic radiation injury can potentially involve multiple pelvic organs,and due to its progressive and irreversible nature,its late stage can be complicated by fistulas,perforations,obstructions and other complications involved multiple pelvic organs,which seriously affect the long-term survival and the quality of life of patients.As a multidisciplinary surgical approach,pelvic exenteration has potential application in the treatment of late complications of pelvic radiation injury by completely removing the irradiated lesion,relieving symptoms and avoiding recurrence of symptoms.In clinical practice,we should advocate the concept of"pelvic radiation injury",emphasize multidisciplinary collaboration,fully evaluate the overall status of patients,primary tumor and pelvic radiation injury.We should follow the principles of"damage-control"and"extended resection",and follow the principle of enhanced recovery after surgery to achieve the goal of ensuring the surgical safety,relieving patients'symptoms and improving patients'quality of life and long-term survival.