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中华疝和腹壁外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (05) : 481 -486. doi: 10.3877/cma.j.issn.1674-392X.2026.05.001

论著

带蒂肌皮瓣转移盆底重建防治全盆腔脏器切除术后空盆腔综合征
仲卫冬, 胡根, 刘金春, 戴丽强, 王镇, 浦凌宵, 耿良栋, 邵国益†()   
  1. 214400 江苏无锡,徐州医科大学江阴临床学院 江阴市人民医院普外科
  • 收稿日期:2026-09-08 出版日期:2026-10-18
  • 通信作者: 邵国益
  • 基金资助:
    无锡市卫生健康委面上项目(M202551); 无锡市卫生健康委科技成果和适宜技术推广项目(T202548); 无锡市卫生健康委"双百"中青年医疗卫生后备拔尖人才项目(HB2023102); 江阴市中青年卫生后备优秀人才项目(JYROYT202301); 徐州医科大学附属医院发展基金重点项目(XYFZ202302)

Pedicled myocutaneous flap transfer for pelvic floor reconstruction to prevent empty pelvis syndrome following total pelvic exenteration

Weidong Zhong, Gen Hu, Jinchun Liu, Liqiang Dai, Zhen Wang, Lingxiao Pu, Liangdong Geng, Guoyi Shao†()   

  1. Department of General Surgery, Jiangyin People's Hospital (Jiangyin Clinical College of Xuzhou Medical University), Wuxi 214400, Jiangsu Province, China
  • Received:2026-09-08 Published:2026-10-18
  • Corresponding author: Guoyi Shao
引用本文:

仲卫冬, 胡根, 刘金春, 戴丽强, 王镇, 浦凌宵, 耿良栋, 邵国益. 带蒂肌皮瓣转移盆底重建防治全盆腔脏器切除术后空盆腔综合征[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(05): 481-486.

Weidong Zhong, Gen Hu, Jinchun Liu, Liqiang Dai, Zhen Wang, Lingxiao Pu, Liangdong Geng, Guoyi Shao. Pedicled myocutaneous flap transfer for pelvic floor reconstruction to prevent empty pelvis syndrome following total pelvic exenteration[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(05): 481-486.

目的

探讨带蒂肌皮瓣转移在防治全盆腔脏器切除术(TPE)后空盆腔综合征(EPS)中的临床疗效。

方法

本研究采用描述性病例系列研究方法。回顾性收集2023年12月至2026年7月,江阴市人民医院普外科10例行全盆腔脏器切除联合肌皮瓣转移盆底重建患者的临床资料。主要观察指标为带蒂肌皮瓣转移盆底重建后EPS相关症状的发生情况,次要观察指标包括肌皮瓣成活情况、盆底创面愈合情况、围手术期并发症发生情况,以及分期手术患者术前负压创面治疗时间和创面感染控制情况。

结果

10例肌皮瓣均成活,术后随访9.0(1.8,22.5)个月,1例因肿瘤复发离世;随访期间均无EPS相关症状,盆底填充满意。盆底手术创面一期愈合3例,延迟愈合7例,其中2例化脓感染,经换药后愈合。供区手术创面一期愈合8例,延迟愈合2例;无供区脓肿、血肿发生;行垂直腹直肌肌瓣转移的2例患者未见腹壁疝形成,其中1例患者术后腹壁切口延迟愈合。

结论

带蒂肌皮瓣转移用于TPE后盆底重建安全可行,可有效填充盆底空腔,降低EPS的发生风险。但这一结论仍需进一步研究验证。

Objective

To evaluate the clinical efficacy of pedicled myocutaneous flap transfer for pelvic floor reconstruction in the prevention and management of empty pelvis syndrome (EPS) following total pelvic exenteration (TPE).

Methods

This retrospective study used a descriptive case-series design. Clinical data were collected from 10 patients who underwent TPE combined with pelvic floor reconstruction using pedicled myocutaneous flaps at the Department of General Surgery, Jiangyin People's Hospital, between December 2023 and July 2026. The primary outcome was the occurrence of EPS-related symptoms following pelvic floor reconstruction. Secondary outcomes included flap survival, pelvic floor wound healing, perioperative complications, and, in patients undergoing staged procedures, the duration of preoperative negative-pressure wound therapy and control of wound infection.

Results

All 10 myocutaneous flaps survived. The median postoperative follow-up was 9.0 months (interquartile range, 1.8 to 22.5 months), during which one patient died of tumor recurrence. No EPS-related symptoms were observed during follow-up, and satisfactory filling of the pelvic dead space was achieved. Primary healing of the pelvic floor surgical wounds was achieved in 3 patients, while delayed healing occurred in 7 patients. Of these 7 patients, 2 developed purulent wound infections that resolved with dressing changes. At the donor sites, primary wound healing was achieved in 8 patients, while delayed healing occurred in 2 patients. No donor-site abscesses or hematomas were observed. Among the 2 patients who underwent vertical rectus abdominis flap transfer, neither developed an abdominal wall hernia, although 1 experienced delayed healing of the abdominal incision.

Conclusion

Pedicled myocutaneous flap transfer appears to be a feasible and potentially safe option for pelvic floor reconstruction following TPE. This technique can provide satisfactory filling of the pelvic dead space and may help prevent EPS. However, further studies are needed to confirm its effectiveness in reducing the risk of EPS.

图1 股前外侧肌皮瓣转移 1A盆底创面清创;1B超声定位旋股外侧动脉降支穿支浅出点,并设计梭形皮瓣;1C分离出的股前外侧肌皮瓣;1D肌瓣填塞盆底深部,皮岛覆盖会阴创面
图2 臀大肌肌皮瓣转移 2A盆底创面清创;2B游离出臀大肌肌瓣;2C肌瓣填塞盆底空腔;2D皮岛覆盖会阴创面并缝合固定
图3 垂直腹直肌肌瓣转移 3A分离出垂直腹直肌肌瓣;3B肌瓣经腹壁裂孔填塞于盆底空腔
图4 双侧臀部V-Y推进皮瓣
图5 腹股沟皮瓣转移 5A脏器切除后的盆底创面;5B游离出腹股沟皮瓣;5C皮瓣覆盖创面;5D供皮区缝合
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