Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions
Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions
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DOI：
10.1046/j.1365-2168.2002.02212.x
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发表时间：
2002-10-01
影响因子：
9.6
通讯作者：
Miyazaki, M
中科院分区：
文献类型：
--
作者：
Koda, K;Tobe, T;Miyazaki, M
背景资料：用于治疗晚期结直肠癌的全盆腔清除术（TPE）通常涉及用于粪便和尿液排泄的双造口，这降低了患者的生活质量。在这项研究中，无造口重建方法的患者通常需要TPE进行了evaluated.Methods：5例患者进行了无造口TPE。在足够的手术边缘切除肿瘤后，在泌尿生殖横膈膜处横切尿道，在肛管处横切直肠。建立回肠新膀胱并进行结肠肛门吻合。大网膜被用来在两个软骨之间构建一个隔膜。结果：所有患者术后均存活12-39个月。4例结肠造口关闭的患者保留了粪便。所有5例患者均能自发排尿，白天排尿困难。除了一个，在癌症复发，移动的在community.Conclusion：Stomaless TPE可以考虑局部晚期大肠癌，侵入泌尿生殖器官，只要肛管，也不影响泌尿生殖隔。
Background: Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated.Methods: Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus.Results: All patients were alive 12-39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community.Conclusion: Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.