摘要
盆腔脏器联合切除术已成为根治性治疗局部晚期/复发直肠癌的重要方式,近年来随着手术技术的进步和围手术期管理能力的提高,患者长期预后显著改善。然而,较高的围手术期并发症发生率严重影响了患者的术后生活质量和恢复进程,目前仍是外科医生面临的主要难题。精准的手术层面和合适的术中体位有助于充分显露术野,准确辨认主要血管,降低术中出血的发生风险。生物补片、肌皮瓣和带蒂大网膜是常见的盆底重建方式,联合其中两种方式修复盆腔缺损可能进一步降低空盆腔综合征的发生率。髂血管重建能有效预防术后血栓形成和室间隔综合征。微创技术的应用和预康复措施的实施有助于减少术后并发症。笔者对盆腔脏器联合切除术后并发症的预防策略进行综述,以期为临床实践和手术推广提供一定参考。
Pelvic exenteration has become an important procedure for radical treatment of locally advanced/recurrent rectal cancer,and in recent years,with the advancement of surgical techniques and the improvement of perioperative management ability,the long-term prognosis of patients has been significantly improved.However,the high incidence of perioperative complications seriously impacts the quality of life of patients and the course of postoperative recovery,which remains a major problem for surgeons.Precise surgical levels and appropriate intraoperative position help to fully expose the surgical field,accurately identify major vessels,and reduce the risk of intraoperative bleeding.Biological mesh,myocutaneous flap and omentoplasty are common pelvic floor reconstruction methods,and combined repair of pelvic defects by two of them may further reduce the incidence of empty pelvic syndrome.Iliac revascularization could effectively prevent postoperative thrombosis and ventricular septal syndrome.The application of minimally invasive techniques and the implementation of pre-rehabilitation measures might help to reduce postoperative complications.This article reviews the prevention strategies of complications after pelvic exenteration in order to provide some reference for clinical practice and surgical promotion.
作者
陶禹
张剑
TAO Yu;ZHANG Jian(Department of Colorectal Surgery,Second Affiliated Hospital of Naval Medical University(Shanghai Changzheng Hospital),Shanghai 200003,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第12期1421-1426,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
国防科技卓越青年科学基金(项目编号:2019-JCJQ-ZQ-002)。
关键词
盆腔脏器联合切除术
并发症
预防
pelvic exenteration
postoperative complication
prevention
