Is Total Pelvic Exenteration Reasonable Primary Treatment for Rectal Carcinoma?
Is Total Pelvic Exenteration Reasonable Primary Treatment for Rectal Carcinoma?
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全盆腔廓清术是直肠癌的合理主要治疗方法吗？
DOI：
10.1097/00000658-198806000-00005
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发表时间：
1988
影响因子：
9
通讯作者：
Scott W. Mcdougal
中科院分区：
文献类型：
--
作者：
L. Williams;C. Huddleston;J. Sawyers;J. Potts;K. Sharp;Scott W. Mcdougal
全盆腔切除术（TPE）是选择性大体积局部浸润性直肠癌患者的合理初次手术治疗，可以整块切除。许多人没有淋巴结或远处转移。此外，TPE可以治愈复发或对放射治疗无反应的类似病变，并且通常是姑息性的。手术死亡率应低于10%，原发病例可低于5%。尽管术前处理和手术技术，特别是尿管和术后护理的改进是明确的，但早期和晚期并发症都是显著的。不幸的是，对于那些需要TPE而不是腹会阴或低位前切除术的患者，手术识别仍然很差。此外，最近骨盆吊带技术的改进，以防止小肠卡压和辐射保护或肌皮瓣，以消除巨大的死腔尚未明确建立作为预防早期或后期并发症。
Total pelvic exeneration (TPE) is reasonable primary surgical therapy in select patients with large bulky locally invasive rectal cancers that can be removed en bloc. Many do not have either nodal or distant metastasis. Furthermore, TPE can be curative and often is palliative for similar lesions that are recurrent or nonresponsive to radiation therapy. Operative mortality rates should be under 10% and can be under 5% for primary cases. Although improvement in preopcrativc management and operative technique, especially with urinary conduits and postoperative care is clear, both early and late complications are significant. Unfortunately, prcoperative identification of those patients requiring TPE rather than abdominoperineal or low anterior resection remains poor. Furthermore, recent improvements in techniques for pelvic slings to prevent small bowel entrapment and protection from irradiation or myocutaneous flaps to obliterate the massive dead space are not yet clearly established as preventers of either early or later complications.