【作者】 王辉； 王仁华； 王斌； 郭杰； 张思杰； 刘放； 刘德营； 李晓霞； 陈玉泽； 季思平； 孟庆凯；

【Author】 Liaoning Provincial Tumor Hospital Department of Large Intestine, Wang Hui Wang Ren—hua Wang Bin Guo Jie,Zhang si—jie Liu fang Liu De—ying Li Xiao—xia,Chen Yu—ze Ma Si—ping Meng Qing—Kai Lin Tao

【机构】 辽宁省肿瘤医院大肠外科；

【摘要】 直肠癌或直肠癌术后复发浸及膀胱三角区和前列腺,引起排尿困难和剧烈疼痛,临床上并不少见。一般都放弃手术或肿瘤姑息切除,术后补加放疗,效果很差。我们对20例直肠恶性肿瘤, 施行全盆腔内脏切除术,取得了较好效果。更多还原

【Abstract】 Objective The objective of this paper is to approach the procedure and indication of pelvic exenteration for carcinoma of rectum. Methods 19 cases with carcinoma of rectum and 1 case with leiomyosarcoma of rectum which invaded bladder and prostate were eligible for the trial. All patients were male and aged from 23 to 68 years. All the patients had disfunction of uri- nation and evacuation. Among these patients, seven patients had intensive pain and six patients with recurrent cancer. 12 cases were performed on radical resection and 8 cases on palliative resec- tion. The highest size of tumor was 30×10cm and the smallest 5×6cm. The patients’ cancer cell differentiation was low. On the basis of Miles’operation, eight patients were performed on ileo- cystoplasty and twelve patients on ureterocutaneostomy. The defective area of peritoneum was re- paired with peritoneum of bladder for 16 cases,wit lateral peritoneum for 3 cases and with omen- turn for 1 case. During operation,four patients’iliac internal arteies and veins were resected and six were ligeted. Results There was no operating mortality in this group. The amount of blood transfusion for each patient was from 400ml to 2000ml,average:750ml. The operating time during operation was from 2 hours 30minutes to 6 hours 20 minutes,average:4 hours 10 minutes. There were 6 patients performed above 5 years. Of the 6 patients,2 patients are alive and 1 patient died of liver metastases at 5—year and 2 months. 8 patients died from recurrence and metastasis in 7～ 28 months after operation. One patient died of renal failure at 35 days after operation. Others still alive. The 5—year survival rate for radical resection was 50%(3/6). The complication of uretero- cutaneostomy acounted for 41.6%(5/12),and the complication for ileocystoplasty acounting for 12.5% (1/8). The symptoms of preoperative intensive pain and urination disfunction disappeared immediately after operation. Conclusions:preserving peritoneum of bladder to repair pelvic peri- toneum was superior to other methods and ileocystoplasty was better than ureteroculaneostomy. We need not resect or ligate the iliac internal arteries and veins routinely. Patients with intensive pain,disfunction of urination,bleeding due to ulceration,and offensive discharges should be treat- ed actively with the pelvic exenteration even if the tumor could not be cured. We think that pelvic exenteration can lengthen patient’s longevity, and improve the quality of life and give patients hope and confidence for live.更多还原