BACKGROUND:Primary tumor resection with simultaneous para-aortic lymph node dissection has curative potential in selected patients with isolated infrarenal para-aortic lymph node metastasis secondary to colorectal cancer. However, para-aortic lymph node dissection is technically challenging, and en bloc resection is difficult. Traditional piecemeal removal may increase the risk of missing lymphatic tissue and contribute to local recurrence. IMPACT OF INNOVATION:A modified "lawn-mowing" technique is introduced for en bloc para-aortic lymph node dissection that simplifies this complex procedure. By initially identifying anatomical boundaries and then systematically removing lymph nodes in a sequential "lawn-mowing" manner, this approach maximizes lymphatic clearance and facilitates appropriate vessel ligation, potentially reducing recurrence and complications. TECHNOLOGY, MATERIALS, AND METHODS:There are 2 steps in the technique: 1) identification of boundaries: establishing the left (left ureter, gonadal vessels, and psoas), distal (left common iliac vein level), right (right ureter, gonadal vessels, and psoas), and proximal (left renal vein) boundaries; and 2) en bloc resection: sequential dissection from distal to proximal and right to left in a "lawn-mowing" pattern, collecting all para-aortic lymph nodes up to the left renal vein and ligating the main lymphatic vessels, superior and inferior to the left renal artery. Key considerations include preserving the sympathetic ganglia and avoiding injury to hemorrhage-prone veins. PRELIMINARY RESULTS:Successful en bloc para-aortic lymph node resection was achieved in a 26-year-old woman with sigmoid colon cancer and para-aortic metastasis. Surgery last 380 minutes and resulted in approximately 100 mL of blood loss. The patient was discharged without complications. Histopathological examination revealed 2 of 23 positive para-aortic lymph nodes. At the 9-month follow-up, there was no recurrence or formation of lymphocysts. CONCLUSIONS AND FUTURE DIRECTIONS:En bloc para-aortic lymph node resection using the "lawn-mowing" technique, after identification of boundaries, is feasible and reproducible. This simplified approach reduces the risk of lymphatic residue. Further evaluation in a larger series is required to assess oncological and functional outcomes. See New Technology Report Video.

Abstract Objective Recurrent vulvar cancer after radiotherapy is a devastating condition that severely impairs patients’ quality of life. Although radical vulvectomy can improve survival and quality of life in primary cases, patients with post-radiation recurrence are at high risk for severe wound-related complications. To address this challenge, our team adopted a combined approach of radical vulvectomy and rectus abdominis flap reconstruction, which has yielded favorable therapeutic outcomes. Methods This retrospective study enrolled patients with radiotherapy-recurrent vulvar cancer who underwent radical vulvectomy combined with rectus abdominis flap reconstruction between 2023 and 2024. The primary endpoint was the change in quality of life, assessed using the EORTC QLQ-C30 and QLQ-VU34 questionnaires. Results Eleven patients underwent radical vulvectomy with rectus abdominis flap reconstruction. The median patient age was 67 years, and the median BMI was 28.98. The median operative time and intraoperative blood loss were 210 minutes and 400 mL, respectively. All patients achieved R0 resection. Nine patients experienced only minor complications (Clavien - Dindo grade II), while two patients developed complications requiring intervention under local anesthesia (grade IIIa). No wound infections, wound dehiscence, or donor-site complications were observed. Postoperatively, a significant improvement in quality of life was evident across all patients, particularly in the domains of physical functioning, pain reduction, and overall global health status (all P < 0.05). Conclusions Radical vulvectomy combined with rectus abdominis flap reconstruction significantly improves quality of life and oncological outcomes in patients with radiotherapy-recurrent vulvar cancer. This combined approach represents a valuable and safe treatment option that merits broader clinical implementation, preferably within a multidisciplinary team setting.

The Tianhe Procedure is a functional sphincter-preserving surgical approach developed for patients with rectal cancer following radiotherapy. This technique involves proximal extended resection of the colon beyond the pelvic cavity, followed by anastomosis of the non-irradiated proximal colon to the distal rectum or anal canal. This strategy aims to reduce the incidence of anastomotic complications and postoperative bowel dysfunction. However, there is currently a lack of standardized practice guidelines for implementing the Tianhe Procedure in China. Therefore, the Chinese Radiation Intestinal Injury Research Group, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, the Anorectal Branch of Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, the Colorectal Cancer Committee of China Anti-cancer Association, and the Gastrointestinal Surgical Branch of Guangdong Medical Doctor Association have jointly convened a panel of national experts to discuss and establish this standardized surgical procedure. This standard, based on the latest evidence from literature, research advancements, and expert experience, focuses on key aspects of the Tianhe Procedure, including its precise definition, indications, critical procedural steps, postoperative complications, and functional rehabilitation strategies. It aims to promote standardized implementation and broader clinical adoption of this innovative surgical technique.

BACKGROUND:Achieving R0 resection in pelvic solid malignancies significantly prolongs survival. However, when these tumors involve the high sacrum (S2 and below), the procedure is often deemed contraindicated due to technical complexity and substantial perioperative risks. OBJECTIVE:To describe a standardized three-step posterior sacral resection technique for high sacrectomy and evaluate its perioperative and oncological outcomes. DESIGN:Retrospective cohort study. SETTINGS:Department of Abdominal and Pelvic Tumor Surgery, The First Affiliated Hospital of Zhengzhou University, and Department of General Surgery, Henan Cancer Hospital. PATIENTS:A total of 47 patients with pelvic solid malignancies (recurrent rectal cancer, chordoma, or presacral malignant teratoma) invading the high sacrum (S2 and below) who underwent surgery between January 2018 and December 2024. INTERVENTION:All patients underwent a standardized three-step posterior sacral resection: (1) posterior exposure and anatomical localization of the sacral level; (2) curvilinear osteotomy using a broad-bladed osteotome with preservation of the presacral venous plexus; (3) neurovascular identification, hemostasis, and pelvic floor reconstruction (e.g., gluteus maximus flap). MAIN OUTCOME MEASURES:Total operative time, duration of sacral resection, intraoperative blood loss, R0 resection rate, postoperative complications (assessed via Neurogenic Bladder Symptom Score), and 5-year recurrence rates. RESULTS:The median total operative time was 245 minutes (IQR, 210-285). The median sacral resection time was 40 minutes (IQR, 35-50), with a median blood loss of 150 mL (IQR, 100-250). All 47 patients (100%) achieved R0 resection. The 30-day and 90-day mortality were 0%. Major complications (Clavien-Dindo ≥ IIIb) were absent. Voiding dysfunction was common but transient: 7 patients (Neurogenic Bladder Symptom Score <20) recovered immediately; 15 (Neurogenic Bladder Symptom Score 20-40) recovered by 3 months; 20 (Neurogenic Bladder Symptom Score 40-60) recovered by 6 months; 5 (Neurogenic Bladder Symptom Score >60) recovered by 12 months. Superficial wound infection occurred in 8 patients (17.0%) and pelvic collection requiring drainage in 5 (10.6%). The median length of hospital stay was 19 days. LIMITATIONS:Single-region study with moderate sample size; lack of a control group for direct comparison with conventional approaches. CONCLUSIONS:This standardized three-step transperineal technique enables rapid, safe, and effective high sacrectomy with high R0 rates and acceptable morbidity, offering a promising option for patients with pelvic malignancies invading the high sacrum. See Video Abstract.

A 35-year-old woman presented with a local recurrence at the stoma site three months after Hartmann’s procedure for sigmoid colon cancer. In the subsequent months, the tumor exhibited rapid progression, with direct invasion into the abdominal wall. Her clinical course was characterized by persistent pain, fever, foul odor, and defecation disorder. The substantial disease burden ​​confined her to bed, leaving her unable to care for her two young children​​. Following a multidisciplinary team (MDT) evaluation, she was deemed a candidate for reoperative surgery. The procedure comprised en bloc resection of the recurrent tumor, followed by restoration of bowel continuity with a primary colorectal anastomosis and immediate abdominal wall reconstruction. The patient’s postoperative recovery was uneventful, with a marked improvement in quality of life. This case highlights the critical role of flap-based reconstruction in managing complex abdominal wall defects.

Large Cell Neuroendocrine Carcinoma (LCNEC) of the cervix is an extremely rare but highly aggressive type of cervical cancer and it requires multimodal therapy to improve their quality of life. At present, there are no established, standardized treatment protocols for managing large cell neuroendocrine carcinoma of the cervix. In this report, we present a case of a patient with cervical LCNEC, Who was a 39-year-old woman who presented with irregular vaginal bleeding accompanied by lower abdominal distension for over a month. Examination revealed a cauliflower-like cervical mass approximately 4cm in diameter, with the normal cervical architecture distorted and partially fused to the vaginal wall. Following further investigations, the stage assigned was IVB, and who was started on neoadjuvant chemotherapy with the TC (paclitaxel + carboplatin) regimen but during neoadjuvant chemotherapy, The patient developed a vaginal urinary leakage. Then, The patient underwent a comprehensive treatment regimen that included pelvic exenteration, urinary system reconstruction, pelvic floor reconstruction, and chemotherapy. Given the patient’s positive immunohistochemistry for EGFR, the treatment was combined with the anti-angiogenic drug, bevacizumab. The patient achieved complete remission following the comprehensive treatment. Through this case to explore individualized treatment for cervical LCNEC.

Objective: To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments). Methods: A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed. Results: Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment (P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments (P＜0.001). Conclusions: Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

Objective To analyze the clinical data including tumor deposits status（TDs） of patients with postoperative TNM（pTNM） stage Ⅱ/Ⅲ gastric cancer, to construct a nomogram prediction model for postoperative recurrence, and to verify its predictive value. Methods The clinical data were collected from 1 015 patients with pTNM stage Ⅱ/Ⅲ gastric cancer, including the preoperative carcinoembryonic antigen（CEA） level, platelet to lymphocyte ratio（PLR）, neutrophils to lymphocytes ratio（NLR）, prognostic nutritional index（PNI）, tumor diameter and tumor location, pTNM stage and TDs. Among them, 706 patients were used as the training set, and another 309 patients were used as the external validation set, who were followed up for 3 years after surgery to record the recurrence. A multivariate Cox proportional hazards regression model was used to analyze the influencing factors of recurrence in patients undergoing radical surgery in the training set. Based on the influencing factors, a nomogram prediction model was constructed to predict recurrence in patients with pTNM stageⅡ/Ⅲ gastric cancer 1and 3years after surgery.The C-index,ROCcurve and calibration curve were used to verify the value of nomogram prediction model to the prediction of recurrence 1and 3years after surgery in two sets.The net reclassification improvement index（NRI）,integrated discrimination improvement index（IDI）,and decision analysis curve were used to analyze the efficiencies and net benefits of the nomogram prediction model and TNM staging system on predicting the recurrence 1and 3years after surgery in two sets.Results Till October2021,the median follow-up time in the training set was 36.1months,and the postoperative 1-,2-and 3-year mortality rates were 9.3%,23.7% and 29.7%,respectively,and the recurrence rates were 14.4%,27.1% and 31.4%,respectively.The median follow-up time in the external validation set was 58 months,and the postoperative 1-,2-and3-year mortality rates were 11.0%,26.2% and 33.7%,respectively,and the recurrence rates were 19.1%,35.0% and39.2%,respectively.Age ≥65 years（HR =1.750,95%CI:1.341-2.283,P=0.001）,CEA ≥8.4μg/L（HR=1.881,95%CI:1.345-2.630,P=0.001）,PNI ＜56.2（HR=1.590,95%CI:1.196-2.114,P=0.001）,leather stomach（HR=2.138,95%CI:1.231-3.713,P=0.007）,positive TDs（HR=1.960,95%CI:1.462-2.629,P=0.001）,and pTNM stageⅡ/Ⅲ （HR=1.778,95%CI:1.549-2.041,P=0.001）were the independent influencing factors for recurrence in the training set 1and 3years after radical surgery.The C-index of the nomogram prediction model in the training set was 0.745（95%CI:0.716-0.774）,and the AUCs for predicting recurrence 1and 3years after surgery were 0.787and 0.781,respectively.In the external validation set,the C-index of the nomogram prediction model was 0.702（95%CI:0.659-0.713）,and the AUCs for predicting recurrence 1and 3years after surgery were 0.714and0.747,respectively.The calibration curve was close to the actual prognosis.The NRIs of the nomogram prediction model related to the TNM staging system for predicting recurrence 1and 3years after surgery in the training set were 0.565and0.420,respectively,while the IDIs were 0.063and 0.082,respectively.The NRIs in the external validation set were0.636and 0.544,respectively,and the IDIs were 0.082and 0.091,respectively.The NRI and IDI were both ＞0,indicating apositive improvement（P＜0.05）.The decision curve analysis showed that the net benefits of the nomogram prediction model for predicting recurrence 1and 3years after surgery in two sets were higher than those of the TNM staging system.Conclusions The gastric cancer patients aged ≥65years,and with CEA ≥8.4μg/L,PNI＜56.2,leather stomach,positive TDs and pTNM stageⅡ/Ⅲ are prone to develop recurrence 1and 3years after surgery.The nomogram prediction model that includes TDs has a high value to the prediction of recurrence 1and 3years after surgery in patients with pTNM stageⅡ/Ⅲ gastric cancer.

Objective: To investigate the causes and management of long-term persistent pelvic presacral space infection. Methods: Clinical data of 10 patients with persistent presacral infection admitted to the Cancer Hospital of Zhengzhou University from October 2015 to October 2020 were collected. Different surgical approaches were used to treat the presacral infection according to the patients' initial surgical procedures. Results: Among the 10 patients, there were 2 cases of presacral recurrent infection due to rectal leak after radiotherapy for cervical cancer, 3 cases of presacral recurrent infection due to rectal leak after radiotherapy for rectal cancer Dixons, and 5 cases of presacral recurrent infection of sinus tract after adjuvant radiotherapy for rectal cancer Miles. Of the 5 patients with leaky bowel, 4 had complete resection of the ruptured nonfunctional bowel and complete debridement of the presacral infection using an anterior transverse sacral incision with a large tipped omentum filling the presacral space; 1 had continuous drainage of the anal canal and complete debridement of the presacral infection using an anterior transverse sacral incision. 5 post-Miles patients all had debridement of the presacral infection using an anterior transverse sacral incision combined with an abdominal incision. The nine patients with healed presacral infection recovered from surgery in 26 to 210 days, with a median time of 55 days. Conclusions: Anterior sacral infections in patients with leaky gut are caused by residual bowel secretion of intestinal fluid into the anterior sacral space, and in post-Miles patients by residual anterior sacral foreign bodies. An anterior sacral caudal transverse arc incision combined with an abdominal incision is an effective surgical approach for complete debridement of anterior sacral recalcitrant infections.

目的 探讨截石位经会阴横弧形切口手术入路在完全切除骶前囊肿术中的应用价值.方法 采用回顾性队列研究方法.收集2012年8月至2021年10月河南省肿瘤医院收治的114例行完全切除骶前囊肿术患者的临床病理资料;男14例,女100例;年龄为(35±9)岁.所有患者术前磁共振成像(MRI)检查诊断为骶前囊肿.114例患者中,76例术中采用截石位经会阴横弧形切口手术入路,设为创新组;38例术中采用Kraske手术入路,设为传统组.观察指标:(1)手术及标本情况.(2)术后情况.(3)随访情况.正态分布的计量资料以(x)±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验.计数资料以绝对数或百分比表示,组间比较采用x2检验或Fisher确切概率法.结果 (1)手术及标本情况.创新组患者手术时间,术中出血量,术中联合经腹入路或切除骶骨例数分别为(137±20)min,(261±101)mL,0;传统组患者上述指标分别为(136±34)min,(261±116)mL,15例;两组患者手术时间和术中出血量比较,差异均无统计学意义(t=0.18,0,P＞0.05);两组患者术中联合经腹入路或切除骶骨例数比较,差异有统计学意义(P＜0.05).两组患者术后标本解剖均显示囊肿完全切除.(2)术后情况.创新组患者术后骶前引流管拔除时间,术后住院时间,术后切口 Ⅱ期愈合例数分别为(11.4±2.1)d,(13.5±3.5)d,23例;传统组患者上述指标分别为(11.5±1.9)d,(13.7±3.8)d,4例;两组患者术后骶前引流管拔除时间和术后住院时间比较,差异均无统计学意义(t=-0.20,-0.24,P＞0.05);两组患者术后切口 Ⅱ期愈合例数比较,差异有统计学意义(x2=5.46,P＜0.05).创新组患者和传统组患者术后出现严重并发症例数分别为4例和2例,两者比较,差异无统计学意义(P＞0.05).(3)随访情况.114例患者均获得随访,随访时间为48(6～108)个月.创新组患者中,2例囊肿复发,传统组患者术后无囊肿复发;两组患者术后囊肿复发例数比较,差异无统计学意义(P＞0.05).随访期间,患者肛门控便功能评价均为Williams分级A～B级.结论 截石位经会阴横弧形切口手术入路用于完全切除骶前囊肿术安全、可行;与Kraske手术入路比较,其更适用于高位骶前囊肿患者.

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.

骶前囊肿是位于骶尾骨与直肠之间的囊性或囊实性肿块，与骶尾骨筋膜、直肠及肛门括约肌等盆底组织关系密切。目前的观点认为其起源与胚胎发育异常有关 ［1, 2, 3］。骶前囊肿会压迫直肠或侵蚀直肠，导致患者排便困难或肠瘘，因此，尽管骶前囊肿多数为良性，其治疗策略仍以手术切除为主 ［4, 5］。但是，如果手术时囊壁没有彻底切除，则会导致复发或骶尾部形成难以愈合的窦道，给患者造成极大的痛苦。骶前囊肿能否完全切除与手术入路有很大关系，不适宜的手术入路不仅不能完全切除囊肿，还容易给患者带来一系列术后并发症，如肠粘连、肠瘘、肛门失禁、性功能障碍等。本文将根据骶前囊肿的位置，探讨相关的手术入路及解剖，以及并发症的处理。

选取50例高位骶前囊肿切除术患者为研究对象，均采用截石位经会阴横行切口入路高位骶前囊肿切除。结果显示50例患者均未采用联合经腹入路或切除骶骨，术后切口Ⅱ期愈合率达30%，无严重的远期并发症。截石位经会阴横行切口入路高位骶前囊肿切除手术安全有效，存在切口愈合困难，但可以显著降低联合经腹手术入路及切除骶骨率。

回顾性分析27例行全盆腔脏器切除手术采用改良Bacon联合带蒂大网膜填塞盆腔空腔患者的临床资料，结果表明27例患者均无空骨盆综合征的发生。该方法可充分填塞盆腔空腔，有效降低术后空骨盆综合征的发生率，在恢复肠道连续性的同时避免了吻合口漏。

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum, almost involving adjacent pelvic floorstructures including sacrococcygeal fascia, rectum, and anal sphincter. Presacral cysts are usually benign, currently believed to arise from aberrant embryogenesis. Presacral cysts are clinically rare and the true incidence is unknown. Surgical resection remains the major treatment for presacral cysts. Unless the cysts are completely resected, recurrence is unavoidable. Recurrent cysts or hard-to-heal sinuses in the sacrococcyx cause patients extreme pain. However, the current knowledge of presacral cysts is insufficient. They are occasionally confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept and skills leads to palliative treatment for complex presacral cysts and serious complications such as impairing the function of the anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts and aims to provide clinicians with a more defined concept of the treatment, standardize the surgical approach, and improve the efficacy of presacral cysts.

Gastrin plays important role in stimulating the initiation and development of many gastrointestinal diseases through interacting with the cholecystokinin 2 receptor (CCK2R). The smallest bioactive unit of gastrin activating CCK2R is the C-terminal tetrapeptide capped with an indispensable amide end. Understanding the mechanism of this smallest bioactive unit interacting with CCK2R on a molecular basis could provide significant insights for designing CCK2R antagonists, which can be used to treat gastrin-related diseases. To this end, we performed extensive Gaussian accelerated molecular dynamics simulations to investigate the interaction between gastrin C-terminal pentapeptide capped with/without amide end and CCK2R. The amide cap influences the binding modes of the pentapeptide with CCK2R by weakening the electrostatic attractions between the C-terminus of the pentapeptide and basic residues near the extracellular domain in CCK2R. The C-terminus with the amide cap penetrates into the transmembrane domain of CCK2R while floating at the extracellular domain without the amide cap. Different binding modes induced different conformational dynamics of CCK2R. Residue pairs in CCK2R had stronger correlated motions when binding with the amidated pentapeptide. Key residues and interactions important for CCK2R binding with the amidated pentagastrin were also identified. Our results provide molecular insights into the determinants of the bioactive unit of gastrin activating CCK2R, which would be of great help for the design of CCK2R antagonists.

骶前囊肿为一种发生于骶前间隙的先天性囊性疾病,多数为良性疾病,目前认为其起源与胚胎发育异常有关.骶前囊肿临床少见,发病率为1:60000～1:40000,主要见于幼儿及成年女性患者(男女比例为1:15) [1-2].由于该类疾病的发病率低,大部分外科医师对其认识模糊,甚至将骶前囊肿与卵巢囊肿、肛周脓肿等疾病相混淆,随之相关治疗也影响了患者的健康恢复.目前,骶前囊肿的治疗以手术完全切除囊肿为主,但缺乏成熟统一的手术入路,加之复杂的骶前解剖结构及"复杂条件下良性囊壁可以残留"的手术理念等,常导致部分复杂骶前囊肿患者的囊壁或囊肿残留,严重者甚至术后会在会阴部形成经久不愈的窦道,给患者带来沉重的身体及经济负担[3-4].骶前囊肿诊疗为我中心特色项目,自2010年以来,成功治疗了约180例初次就诊或外院多次骶前囊肿切除术后复发的患者.本文结合我中心的诊疗经验,就骶前囊肿的特点、诊断及手术入路等进行综述,旨在提高外科医师对该疾病的认识,树立骶前囊肿治疗的正确理念,提高囊肿完全切除技巧,以期提高骶前囊肿的治愈率.

walls and we designed a novel surgical approach for presacral cystic tumor resection, namely transperineal tumor resection with an arc-shaped incision anterior to the apex of the coccyx. Here, we present the details and outcomes of this novel surgical approach.

Objective:To investigate the types, surgical treatments of complex intestinal fistula after radiotherapy for cervical cancer.Methods:The clinical data and treatment of 26 patients with complex intestinal fistula after radiotherapy for cervical cancer at Cancer Hospital of Zhengzhou University from Jan 2013 to Jan 2020 were reviewed .Results:Eleven patients were with recto-vaginal fistula, 1 patient with sigmoido-vesical fistula, 5 patients with combined rectal, vaginal and vesical fistula, 7 patients with low rectal fistula and peripheral infection, and 2 patients with ileo-vaginal stump fistula after radical resection of cervical cancer and adjuvant radiotherapy. All patients were underwent the surgery, including 9 patients for total pelvic or posterior pelvic resection, 6 patients for rectum or sigmoid colectomy, bladder or vaginal repair, 7 patients were done for Hartmann surgery, and 1 patient underwent segmental resection, enteroanastomosis and vaginal repair, 3 patients for transverse colostomy or proximal ileostomy. No major postoperative complications occurred . The symptoms of intestinal fistula in all patients were dissolved, and the perineal pain was significantly relieved in 23 patients. The symptoms of ileal fistula reccurred in 2 patients within 1 year after operation, and there was no mortality.Conclusions:The rectal related intestinal fistula is the most common complex intestinal fistula after radical radiotherapy for cervical cancer. The point of surgical treatment is to remove the diseased rectum or ileum.