系统描述扩大盆腔廓清术（EPE）后4个阶段递进式盆底重建的临床实施、基线特征、术中数据、术后恢复、空盆腔综合征（EPS）并发症分布，呈现389例单中心资料全貌，为标准化盆底重建提供依据。

本研究为基于前瞻性中国盆腔脏器联合切除数据库的回顾性描述性研究。连续纳入2021年11月至2026年1月于海军军医大学第二附属医院行盆底整块切除的EPE盆腔肿瘤患者389例。按盆底重建、空腔填塞、创面处理、放疗患者消化道重建分为四个阶段。记录各阶段人口学、术前基线、术中指标、术后恢复及并发症。本研究为描述性研究，不进行4个阶段组间假设检验。

4个阶段技术逐级增加：生物补片→大网膜填塞→分期负压创面管理→放疗高危患者回盲部预防性切除。4个阶段各阶段手术时长中位数520~560 min、出血量中位数740~880 ml，R₀切除率80.0%~86.2%。会阴创面处理由一期缝合逐步转为敞开分期负压管理。各阶段术后排气时间中位数60~72 h，引流管留置时间中位数50~80 d、住院时间中位数38~75 d，空盆腔痊愈时间中位数62~82 d。ClavienDindo<Ⅲ级并发症52.8%~68.0%，围手术期死亡仅见于前两阶段。第四阶段（n=36）未观察到肠瘘、肠会阴瘘、盆腔出血、皮瓣相关并发症（0/36），受样本量限制尚待验证，仍存在盆腔深部积液、肠梗阻、泌尿系重度并发症。

4个阶段递进策略可逐层优化盆底修复、创面管理及放疗高危患者个体化处理，观察到EPS相关重度并发症数量呈下降趋势，有助于改善围手术期安全与创面愈合质量，可为EPS精准防控与加速康复提供临床借鉴。

To systematically describe the clinical implementation of four-stage progressive pelvic floor reconstruction following extended pelvic exenteration (EPE), including baseline characteristics, intraoperative parameters, postoperative recovery, and the distribution of complications related to empty pelvis syndrome (EPS). A total of 389 cases from a single center were included, so as to provide comprehensive overview and evidence for standardized pelvic floor reconstruction.

This retrospective descriptive study extracted data from a prospective Chinese pelvic exenteration database. A total of 389 consecutive pelvic tumor patients receiving EPE with en bloc pelvic floor resection at the Second Affiliated Hospital of Naval Medical University from November 2021 to January 2026 were included. Reconstruction was categorized into four stages according to pelvic floor repair, pelvic cavity obliteration, wound management and gastrointestinal reconstruction for radiated patients. Demographics, preoperative baseline, intraoperative indicators, postoperative recovery and complication data were collected. Given its descriptive nature, no intergroup hypothesis tests between four stages were performed.

The four-stage technique was implemented in a stepwise manner: biological mesh reconstruction→greater omental packing→staged negative-pressure wound therapy→prophylactic ileocecal resection for high-risk patients receiving radiotherapy. The median operative duration across the four stages ranged from 520 to 560 min, median blood loss ranged from 740 to 880 ml, and R₀ resection rate ranged from 80.0% to 86.2%. Perineal wound management evolved from primary closure to open staged negative-pressure therapy. The median time to first postoperative flatus across the four stages was 60 to 72 hours, drainage tube indwelling duration was 50 to 80 days, hospital stay was 38 to 75 days, and time to complete healing of the empty pelvis was 62 to 82 days. The proportion of complications with Clavien-Dindo grade<Ⅲ ranged from 52.8% to 68.0%. Perioperative mortality was only observed in the first two stages. In Stage 4 (n=36), no enterocutaneous fistula, perineoenteric fistula, pelvic hemorrhage or flap-related complications were observed (0/36). This finding remains to be validated due to limited sample size; deep pelvic collection, bowel obstruction and severe urological complications still existed.

The four-stage progressive strategy achieves layered optimization of pelvic floor repair, wound management and individualized intervention for radiotherapy-high-risk patients. Reduced severe EPS-associated complications were noted, which is conducive to improving perioperative safety and wound healing quality, and offering clinical reference for precise EPS prevention and enhancedrecovery.