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盆腔脏器联合切除术的概念更新与临床实践#br#

顾    晋,洪昊鹏   

  1. 北京大学肿瘤医院胃肠肿瘤外科,北京 100142
  • 出版日期:2025-01-01

  • Online:2025-01-01

摘要: 近年来,关于盆腔脏器联合切除术(PE)的多中心研究在国际上广泛报道,取得了令人振奋的远期生存效果,手术概念也随之发生变化。PE的主要目标是通过彻底切除受肿瘤侵袭的盆腔器官,达到肿瘤完全切除(R0切除)与整块切除(en bloc切除),以期提高病人的生存率和生活质量。对于局部晚期的肿瘤病人,全身系统性化疗或局部放疗可以使原本无法达到R0切除的肿瘤转变为可切除肿瘤,为PE创造条件。相较于新辅助治疗,辅助治疗可以更好地改善部分PE病人的术后远期生存。尽管PE能够显著提高某些局部晚期或复发性盆腔恶性肿瘤病人的生存率和生活质量,但其高并发症风险需要在术前进行全面评估和准备,在术后需要多学科综合治疗协作组(MDT)的密切合作和给予综合治疗,以尽可能降低并发症发生率及其严重程度。

关键词: 盆腔脏器联合切除术, 总生存期, 并发症

Abstract: In recent years,multicenter studies on pelvic exenteration (PE) have been widely reported internationally,achieving encouraging long-term survival outcomes and leading to changes in the surgical concept. The primary goal of PE is to achieve complete (R0) resection and en bloc removal of tumor-invaded pelvic organs,aiming to improve patient survival rates and quality of life. For patients with locally advanced tumors,systemic chemotherapy or local radiotherapy can transform tumors that were initially unresectable into resectable ones,creating conditions for PE. Compared to neoadjuvant therapy,adjuvant therapy can better improve postoperative long-term survival for some PE patients. Although PE can significantly improve the survival rate and quality of life for certain patients with locally advanced or recurrent pelvic malignancies,its high risk of complications requires comprehensive preoperative assessment and preparation. Postoperatively,close collaboration and comprehensive treatment from a multidisciplinary team(MDT) are necessary to minimize the incidence and severity of complications as much as possible.

Key words: pelvic exenteration, overall survival, complication