BACKGROUND:To determine guidelines for the management of perineal small bowel fistula (PSF) after total or posterior pelvic exenteration. METHODS:During 15 years, 315 curative pelvic exenterations were performed. PSF occurred in 15 patients (3.5%). We retrieved the precise modality of radiotherapy (fields and doses) and management of all patients (type of surgery, number of surgery and mortality). Delay of occurrence was divided in early (within 30 days or before hospital discharge) and delayed. RESULTS:All patients underwent surgery. Mortality rate was 13%. Fourteen patients (93%) had history of radiotherapy. No PSF was noted after anterior pelvic exenteration. Higher frequency of PSF was noted after total pelvic exenteration versus posterior pelvic exenteration (P = 0.04). Early PSF occurred in four patients (27%) with higher frequency of small bowel intraoperative injury. Late PSF occurred in 11 patients (73%) divided in small bowel injury in contact with pelvic staples (n = 4) and disease recurrence (n = 6, local recurrence or carcinomatosis). One patient had delayed PSF by ulceration of small bowel in contact with pelvic drain. CONCLUSION:PSF was a life-threatening complication of pelvic exenteration. Radiotherapy leads to weaken small bowel with difficulty of cicatrisation. During pelvic exenteration: (a) extreme careful dissection and interposition of great omentum could avoid small bowel injury, (b) control of pelvic vessels and closure of rectum remnant should not used staplers. Intraoperative management of PSF used successful simple repair in case of early PSF or segmentary resection indeed enlarged to right colon in case of delayed PSF. Postoperative courses had to use intravenous hyperalimentation and digestive tract discharge.

译文

摘要背景:确定盆腔全盆或后盆取出后会阴小肠瘘(PSF)的治疗指南。
方法:在15年的时间里,进行了3​​15例根治性盆腔切除术。 PSF发生在15例患者中(3.5%)。我们检索了放疗的精确方式(范围和剂量)和所有患者的治疗方法(手术类型,手术次数和死亡率)。延迟发生的时间分为早期(30天以内或出院前)并延迟。
结果:所有患者均接受手术治疗。死亡率为13%。十四名患者(93%)有放疗史。骨盆前部脱出后未发现PSF。盆腔全切术后PSF发生频率高于盆腔后全切术(P = 0.04)。早期PSF发生在四例(27%)小肠手术中发生率较高的患者中。晚期PSF发生在11例患者中(73%),分为小肠损伤与骨盆吻合钉(n = 4)和疾病复发(n = 6,局部复发或癌变)。一名患者因与肠盆引流接触的小肠溃疡而延迟了PSF。
结论:PSF是导致盆腔引伸死亡的并发症。放射疗法会导致小肠变弱,难以愈合。在盆腔排出术中:(a)仔细仔细地解剖和插入大网膜可避免小肠损伤,(b)盆腔血管的控制和直肠残余物的封闭不宜使用吻合器。 PSF的术中管理是在PSF早期的情况下成功进行了简单的修复,或在PSF延迟的情况下确实扩大到了右结肠的部分切除术。术后课程必须使用静脉营养过高和消化道分泌物。

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