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目的总结低位直肠癌累及远端阴道及会阴体时行后盆腔脏器切除及远端阴道及会阴体切除后会阴重建的各种方法的应用体会。方法总结我院2008年10月至2013年9月期间收治的10例直肠癌联合远端阴道及会阴体切除后的重建方式及围手术期的临床资料。结果 10例患者中2例行子宫及阴道全切除,3例行子宫及阴道后壁切除,5例行单纯远端阴道和(或)会阴体切除。分别采用大网膜填塞(4例)、阴道前壁翻转缝合(3例)、子宫后倾(2例)、带蒂乙状结肠(2例)重建盆腔及阴道会阴缺损。1例患者盆腔严重感染,2例患者会阴部切口感染或裂开。结论女性低位直肠癌患者行后盆腔联合脏器切除后切口相关并发症率极高,可根据盆腔、会阴及阴道的缺损情况选用子宫或网膜填塞盆腔、带蒂肠段或肌皮瓣、生物补片等方法进行一期修复缺损,采用腹直肌或臀大肌肌皮瓣修复会阴巨大缺损成为目前主流的修复方式,但国内该技术报道极少,值得积极开展应用。
Objective To summarize the experience of various methods of pelvic organ excision and distal vaginal and perineal reconstruction after low distal rectal cancer involving distal vagina and perineal body. Methods The clinical data of 10 cases of rectal cancer combined with distal vaginal and perineal resection in our hospital from October 2008 to September 2013 were retrospectively reviewed. Results 2 of 10 patients underwent total hysterectomy and vaginal resection, 3 underwent resection of the uterus and vagina, and 5 underwent simple distal vaginal and / or perineal resection. Pelvic and vaginal perineal defects were reconstructed with omental obliteration (4 cases), anterior vaginal suture inversion (3 cases), posterior uterine leaning (2 cases) and pedunculated sigmoid colon (2 cases). One patient had a severe pelvic infection and two patients had perineal incision infection or dehiscence. Conclusions In patients with low rectal cancer, the incidence of incision-related complications after pelvic and visceral resection is extremely high. Pelvic, pedicled intestine or myocutaneous flap may be selected according to pelvic, perineal, and vaginal defects. Patch and other methods for a repair defect, the use of rectus abdominis muscle or giant muscle myocutaneous flap repair perineal huge defect has become the mainstream of the repair, but the domestic few reports of the technology, it is worthwhile to actively carry out the application.