Utility of the Omentum in Pelvic Floor Reconstruction Following Resection of Anorectal Malignancy Patient Selection, Technical Caveats, and Clinical Outcomes
Utility of the Omentum in Pelvic Floor Reconstruction Following Resection of Anorectal Malignancy Patient Selection, Technical Caveats, and Clinical Outcomes
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DOI：
10.1097/sap.0b013e3181ce3947
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发表时间：
2010-05-01
影响因子：
1.5
通讯作者：
Kim, Hong J.
中科院分区：
文献类型：
--
作者：
Hultman, Charles S.;Sherrill, Matthew A.;Kim, Hong J.
本研究评估了大网膜在肛门直肠恶性肿瘤腹会阴联合切除术或盆腔清除术后重建复杂会阴缺损中的作用。（平均年龄：59岁）的肛门直肠恶性肿瘤患者行腹会阴联合切除术（n = 57）或盆腔清除术（n = 13），仅行一期修复术（n = 13例，大网膜一期修复16例，单纯肌皮瓣修复28例，带大网膜肌皮瓣修复13例。采用Student t检验和卡方分析比较有无网膜瓣的患者。大网膜皮瓣以单蒂为基础，在Treitz韧带外侧的结肠后平面穿隧，穿过骶骨移位至盆底，29例患者用大网膜重建盆底和会阴，41例患者不用大网膜重建。无大网膜组盆腔主要并发症（脓肿、尿瘤、深静脉血栓、皮瓣裂开、疝、肠梗阻、瘘）的发生率（25/41例，61%）高于大网膜组（6/29例，21%）（P < 0.01）。在年龄、分期、放疗发生率、失血量、住院时间或死亡率方面没有观察到差异。在复杂的会阴部缺损重建中，使用大网膜作为初级皮瓣或与肌皮瓣联合使用，与术后并发症发生率降低相关，强烈支持大网膜在盆底重建中的应用。
This study assesses the usefulness of the omentum in the reconstruction of complex perineal defects, following abdominoperineal resection or pelvic exenteration, for anorectal malignancy.Between 2000 and 2008, 70 patients (mean age: 59 years) with anorectal malignancy underwent abdominoperineal resection (n = 57) or pelvic exenteration (n = 13) and were reconstructed by primary repair alone (n = 13), primary repair with omentum (n = 16), myocutaneous flap alone (n = 28), or myocutaneous flap with omentum (n = 13). Patients with and without omental flaps were compared by Student t test and chi(2) analysis. Omental flaps were based on a single pedicle, tunneled in the retrocolic plane lateral to the ligament of Treitz, and transposed across the sacrum to the pelvic floor.In total, 29 patients had pelvic floor and perineal reconstruction with the omentum, and 41 patients had reconstruction without the omentum. Incidence of major pelvic complications (abscess, urinoma, deep vein thrombosis, flap dehiscence, hernia, bowel obstruction, fistula) was greater in the "no omentum" group (25/41 patients, 61%), compared with the "omentum" group (6/29 patients, 21%) (P < 0.01). No differences were observed regarding age, stage, incidence of radiotherapy, blood loss, length of stay, or mortality.Use of the omentum as a primary flap, or in combination with a myocutaneous flap, in the reconstruction of complex perineal defects, is associated with a decreased incidence of postoperative complications, strongly supporting the use of the omentum in pelvic floor reconstruction.