The use of a biodegradable mesh to prevent radiation-associated small-bowel injury.
The use of a biodegradable mesh to prevent radiation-associated small-bowel injury.
复制标题
使用可生物降解的网来预防与辐射相关的小肠损伤。
作者：
K. Dasmahapatra;A. Swaminathan
放射相关性小肠损伤发生在盆腔癌手术后接受术后放射治疗的患者中高达50%。我们描述了我们的经验，使用可生物降解的网，使小肠支持以上的骨盆入口，并完全吸收后，放射治疗。在1985年至1989年期间，对45例直肠癌患者进行了手术（前切除术15例，腹会阴切除术23例，盆腔清除术6例，直肠结肠切除术1例）。30例患者使用聚乙醇酸（Dexon）补片，15例患者使用聚乳糖910（Vicryl）补片。44例患者接受术后放疗。平均（+/- SEM）剂量为56.8 +/- 18.4戈伊。没有与补片相关的即刻并发症。随访时间范围为12至53个月（中位随访时间为34个月）。除了两名使用聚乳糖910补片的患者因前腹壁下粘连而发生肠梗阻外，没有记录到临床放射相关小肠损伤的发生率。使用可吸收补片可以允许我们使用更高剂量的术后放疗，而不会产生放射相关小肠损伤的相关危害。
Radiation-associated small bowel injury occurs in up to 50% of patients receiving postoperative radiotherapy following pelvic cancer surgery. We describe our experience using a biodegradable mesh that allows the small bowel to be supported above the pelvic inlet and is totally absorbed following radiation therapy. Between 1985 and 1989, 45 procedures were performed in patients with carcinoma of the rectum (anterior resection in 15 patients, abdominoperineal resection in 23 patients, pelvic exenteration in six patients, and proctocolectomy in one patient). In 30 patients a polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin 910 (Vicryl) mesh was used. Forty-four patients received postoperative radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no immediate complications related to the mesh. Follow-up ranged from 12 to 53 months (median follow-up, 34 months). With the exception of two patients who had a polyglactin 910 mesh and who developed bowel obstruction due to adhesions under the anterior abdominal wall, there has been no documented incidence of clinical radiation-associated small bowel injury. The use of the absorbable mesh may permit us to use higher doses of postoperative radiotherapy without the associated hazard of radiation-associated small bowel injury.