中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (02): 220-226.DOI: 10.19538/j.cjps.issn1005-2208.2025.02.16

• 论著 • 上一篇    下一篇

女性后盆腔廓清术后保功能会阴重建6例分析

常    毅1，江慧洪2，李阿建2，丁海波2，汤二将3，黄    玲4，唐    翠5，孙成瑜6，方亚萍4，黄    瑾1，张晓健1，王    松2，林    寅2，刘海龙2，冯少清7，林谋斌2   

  1. 1同济大学附属杨浦医院整形美容科，上海 200090；2同济大学附属杨浦医院普通外科，上海 200090；3同济大学医学院胃肠外科和转化医学研究所，上海 200090；4同济大学附属杨浦医院消化内科，上海 200090；5同济大学附属杨浦医院放射科，上海 200090；6同济大学附属杨浦医院超声科，上海 200090；7上海交通大学医学院附属第九人民医院整复外科，上海 200011
  • 出版日期:2025-02-01 发布日期:2025-02-26

  • Online:2025-02-01 Published:2025-02-26

摘要： 目的    探讨女性后盆腔廓清术后保功能会阴重建（即修补会阴缺损时重建肛门和阴道功能）的临床应用效果。方法    回顾性分析同济大学附属杨浦医院2023年11月至2024年7月间行后盆腔廓清术后保功能会阴重建的6例女性局部晚期或复发性肛管直肠癌病人的临床资料。结果    6例病人均施行了后盆腔廓清术，并用股薄肌瓣结合不同穿支皮瓣的组合方式，同时完成了肛门的原位重建、阴道的修补、会阴缺损关闭和盆腔空隙的充填。1例病人采取单纯股薄肌瓣，3例病人采取复合股薄肌肌皮瓣，2例病人采取组合股薄肌瓣+股深动脉穿支皮瓣。本组病人手术时间为（405±86.2） min min，其中肌瓣切取及盆底重建的手术时间为（155±37.4） min，术中出血量为260（280，410） mL，术后住院时间为15（14，20） d。6例病人均完成阴道修复，术后1例病人出现会阴切口感染，经2周换药愈合。5例病人完成生物反馈初级疗程后，原位重建肛门最大收缩压为（213.8±15.4） mmHg（1 mmHg=0.133 kPa），持续挤压时间为（14.3±1.0）s；3例病人完成高级疗程后，原位重建肛门静息压为（56.2±18.6） mmHg，高压带长度为（2.6±0.5） cm。6例病人术后中位随访时间为5.8（3.5，7.1）个月，均未见肿瘤复发转移迹象，亦未见肌皮瓣坏死或萎缩等情况。结论    对于局部晚期或复发性肛管直肠癌病人，在施行后盆腔廓清术后行保功能会阴重建是安全可行的，兼顾了肿瘤根治和器官功能恢复的双重目标。

关键词: 肛管直肠癌, 后盆腔廓清术, 会阴重建, 肛门重建, 生物反馈治疗

Abstract: To investigate the safety and feasibility of functional perineal reconstruction (reconstructing the anus and vagina function while repairing perineal defect) in posterior pelvic exenteration (PPE). Methods    A retrospective analysis was conducted on the clinical data of 6 female patients with locally advanced or recurrent rectal and anal cancer who underwent PPE and functional perineal reconstruction at Yangpu Hospital affiliated to Tongji University School of Medicine from November 2023 to July 2024. Results    All 6 patients received PPE with a combination of gracilis flap and different perforator flaps, which simultaneously restored the anus, repaired the vagina, closed the perineal defect, and filled the pelvic space. 1 patient received a gracilis flap, 3 patients received a compound gracilis myocutaneous flap, and 2 patients received a combined gracilis flap with profunda artery perforator flap. The mean duration for complete posterior exenteration was (405±86.2) min. The mean duration for muscle flap excision and pelvic floor reconstruction was (155±37.4) min. The median blood loss was 260 (280, 410) mL. The median postoperative stay was 15 (14, 20) days. All patients successfully repaired the vagina, but one patient had an infected perineal incision that healed after 2 weeks of dressing changes. 5 patients have completed the primary biofeedback program, and the maximum squeeze pressure was (213.8±15.4) mmHg and continuous extrusion time was (14.3±1.0) s of the reconstructed anus. 3 patients have completed the advanced biofeedback program, and the anal resting pressure was (56.2±18.6) mmHg and high pressure zone was (2.6±0.5) cm of the reconstructed anus. The median follow-up time of the 6 patients was 5.8 (3.5, 7.1) months, and no signs of tumor recurrence or metastasis were found, nor was necrosis or atrophy of the myocutaneous flap observed. Conclusion    For locally advanced or recurrent rectal and anal cancer patients, it is safe and feasible to perform functional perineal reconstruction in PPE, which achieves the dual goals of tumor resection and organ function restoration.

Key words: rectal and anal cancer, posterior pelvic exenteration, perineal reconstruction, anal reconstruction, biofeedback therapy