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FRONT IMPRESSIONS OF SMALL PANCRE WITH RECONSTRUCTION OF MUSCULAR SLOT IN PATIENTS WITH LOCALLY EXTENDED..,
Tilliashaykhov Mirzogolib Nigmatovich, director of Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology Zakhirova Nargiza Nematovna, Leading researcher of Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
E-mail: evovision@bk.ru
FRONT IMPRESSIONS OF SMALL PANCRE WITH RECONSTRUCTION OF MUSCULAR SLOT IN PATIENTS WITH LOCALLY EXTENDED UTERINE CERVICAL CANCER
Abstract: The immediate and immediate results of pelvic exenteration were studied in 32 patients with MR cervical cancer who underwent anterior exenteration of pelvic organs with a muscular flap reconstruction of the pelvic floor. The reasons that have a significant impact on the development of postoperative complications, the advantages of pelvic floor plastic, which reduces the incidence of postoperative complications, are analyzed. Keywords: cervical cancer, pelvic exenteration, reconstructive-plastic surgery.
The possibilities of treating patients with locally advanced performed by anterior excretory of the pelvic organs (EMT)
with a one-stage pelvic floor plasty with a muscle flap from 2005 to 2014 on the basis of the RHCM Ministry of Health of the Republic of Uzbekistan and the Tashkent city oncology dispensary. The age of patients ranged from 32 to 61 years, the average age was 46.5 years. Morphologically, squamous cell carcinoma was diagnosed in 29 patients (90.6%), adenocarcinoma in 3 patients (9.4%).
All examined patients underwent a thorough preoperative examination: ultrasound of the abdominal cavity and small pelvis, MRI of the small pelvis and retroperitoneal space with contrast, CT of abdominal and thoracic organs, excretory urography with retrograde cystography, cystoscopy, rectosigmoscopy. An important aspect of the preoperative examination was the determination of the degree of spread of the tumor process to neighboring organs.
The results are their discussion. All examined patients underwent anterior exenteration of the pelvic organs (EMT), with a one-stage plastic reconstruction of the pelvic floor with a muscular flap, as well as bilateral aorto-iliac and tazovoob-turator lymphadenectomy. One surgeon performed all operations. Indications for EMT were: recurrent bleeding from the genital tract, discharge of urine from the vagina (vesicovaginal fistulas), hematuria, chronic pain syndrome, ureterohydrone-phrosis with one or two sides, extremely low quality of life. The duration of the operation was from 2 hours 43 minutes to 8 hours 05 minutes, depending on the type of urine diversion produced. Methods of withdrawal of urine and duration of surgery directly depended on the clinical situation and intraoperative findings.
Given the relatively high operational and anesthetic risks, the decision to perform such a traumatic operation was usually taken by a doctor's consultation, after a thorough explanatory
cervical cancer (MR cervical cancer), with continued growth and recurrence of the disease are very limited, and the results of the currently available therapeutic approaches are not satisfactory [1]. More than a third of patients with untreated, recurrent and MR cervical cancer do not go beyond the pelvic floor until death, and they rarely metastasize. These patients are more likely to die from bleeding from a disintegrating tumor, uremia, intestinal obstruction or cachexia [3].
This circumstance prompted surgeons to develop multi-visceral resections and superextended operations, which include the exenteration of pelvic organs. Despite the fact that for some time this operation was the object of considerable criticism, now it is recognized as a method of choice for the treatment of those patients who will not be helped by other methods of therapy. The technical complexity, the high incidence of intra- and postoperative complications, the large postoperative lethality, the unsatisfactory quality of life of the operated patients, the difficulties of rehabilitation, as well as the significant level of economic costs with low treatment effectiveness, is causing a negative attitude among oncologists [4]. But the technique of implementation is improved and a decrease in mortality and complications is noted, and encouraging indicators of 5-year survival are accumulating. In this regard, it seems relevant to improve the development and implementation of effective techniques for reconstructive-recovery operations of the pelvic floor of exenteratics of pelvic organs.
Purpose of the study. To study the immediate results of treatment of patients after anterior exenteration of the pelvic organs with a one-stage plastic pelvic floor with a muscle flap.
Material and methods of investigation. The analysis of the nearest results of treatment of 32 patients with MR cervical cancer (T2b-4N0-1M0) was performed, which was
Section 7. Medicine
conversation with the patient and her relatives after receiving their consent for the operation.
Ureterocutaneostomy (UCS) was performed by 15 (46.9%), Brikker 9 (28.1%) and colonic urinary reservoir with controlled evacuation in 8 (25.0%) patients with MR SFS
All examined patients underwent reconstruction of the pelvic floor after exenteration with a muscle graft. In our study, a flap from the lower half of the left rectus abdominis muscle on the feeding stem (VRAM flap) was used to reconstruct the pelvic floor. The muscles in the form of a cascade, the postoperative field, the so-called "empty pelvic floor" formed after EMT, were cross-linked by vikrilov or catgut threads, which prevents and / or reduces the formation of complications such as lymphocele and pelvic abscesses, pelvic hernias, intestinal obstruction, due to the translocation of loops of the intestines into the cavity of the small pelvis and adhesion to the walls of the small pelvis, small intestinal fistulas, rectal-vaginal fistulas.
As can be seen from the table, the most frequent complications were suppuration of the postoperative wound and
pyelonephritis, 12.5% and 15.6% of cases, necrosis of the displaced muscular flap was observed in 9.4% of cases of patients. The frequency of development of the above complications, in our opinion, is related to the intra-operative technical difficulties that have taken place due to pronounced and fibrotic changes in the small pelvis. Two patients (6.3%) complained of difficulties in self-cate- geration, and 1(3.1%) developed a small intestine obstruction, which was resolved in a conservative way. Fatal outcome occurred in 1(3.1%) of the patient, the cause of death - pulmonary embolism.
Conclusions: The applied procedure for reconstructing the pelvic floor after pelvic exenteratics, especially with the formation of a large intestine urinary reservoir with controlled emptying, is the most optimal volume of surgical intervention, reduces the risk of early postoperative complications such as intestinal obstruction, rectal-vaginal fistulas, small abscesses pelvis and pelvic hernia, which significantly improves the quality of life of patients.
References:
1. Aglullin I. R., Didakunan F. I., Aglullin T. I., Ziganshin M. I., Valiev A. A. Results of eviscerations of pelvic organs with one-stage plasty // Povolzhsky oncologic herald. 2014.- No. 2.- P. 42-45.
2. Kosenko I. A., Matylevich O. P. Examination of the pelvis in patients with cervical cancer: a review of the literature // Oncological Journal.- No. 4 (8).- P. 82-89.
3. Matylevich O. P., Kosenko I. A., Krasin S. A., etc. The nearest results of pelvis exenteration in patients with cervical cancer // Oncological Journal. 2010.- No. 4.-FROM.- P. 22-7.
4. Aiba T., Uehara K., Tsukushi S., Yoshino Y., Ebata T., Yokoyama Y., Igami T., Sugawara G., Nagino M. Perineal alveolar soft part sarcoma treated by laparoscopy-assisted total pelvic exenteration combined with pubic resection // Asian J. Endosc. Surg. 2016.- P. 123-42.
