吻合器低位直肠结肠吻合在妇科肿瘤盆腔根治性手术中的应用

目的　评价在妇科肿瘤盆腔根治性手术中采用吻合器进行直肠结肠吻合的有效性及其并发症。方法　回顾性分析 2 0 0 1年 3月～ 2 0 0 4年 2月我院 11例妇科肿瘤患者的资料 ,所有患者均接受晚期卵巢癌的首次细胞减灭术或其他妇科盆腔复发灶再次切除术 ,术中将盆腔腹膜内原发灶和转移灶连同部分直肠结肠整块切除 ,同时用吻合器将直肠结肠端端吻合。结果　 11例患者的平均年龄为 5 4 .7岁 ,其中Ⅲ～Ⅳ期上皮性卵巢癌 9例 ,宫颈癌和宫体癌各 1例。 8例卵巢癌患者在首次细胞减灭术中 ,连同原发卵巢肿瘤、盆腔转移灶及部分直肠结肠完整地切除 ,并行低位直肠结肠吻合术 ,其中 7例 (87.5 % )术后残留灶 <1cm。其他 3例复发性盆腔肿瘤 ,切除复发灶和部分直肠结肠 ,无可见肿瘤残存。除 1例膀胱排尿困难外 ,未发生吻合口漏 ,无围手术期死亡。平均随访 19.3个月 ,除 1例复发性卵巢癌患者术后 6个月死于肝转移外 ,其余 10例均无瘤生存。结论　在晚期妇科肿瘤手术中 ,使用吻合器行低位直肠结肠吻合有利于盆腔肿瘤的完整切除 ,并发症极少

Low colorectal staple anastomosis after radical pelvic surgery for gynecologic malignancies

Objective To assess the value of staple low colorectal anastomosis after radical pelvic surgery for gynecologic malignancies.Methods The medical records of patients who underwent staple colorectal anastomosis after radical pelvic surgery between March 2001 and February 2004 were reviewed.Results 11 patients with mean age of 54.9 year including 9 patients (81.8%) with advanced ovarian cancer, one recurrent endometrial cancer and one recurrent cervical cancer. During the primary cytoreduction of 8 patients with primary ovarian cancer, en bloc rectosigmoid colectomy with primary staple anastomosis was performed without protective intestinal diversion. Seven patients (87.5%) were left with optimal (<1 cm) residual lesion. The other 3 patients with recurrent pelvic disease under-gone the same staple anastomosis after radical pelvic surgery, were obviously tumor free, except one with bladder dysfunction. There was neither anastomotic fistula nor postoperative death. All 11 patients were subjected to postoperative chemotherapy or radiotherapy. 10 survived with disease-free with only one death due to liver metastasis in 6 months during a mean follow-up of 19.3 months. Conclusion Radical pelvic surgery with staple low colorectomy anastomosis facilitates complete resection of primary and recurrent locally advanced gynecologic malignancies. The complication rate of the procedure is very low.