| 摘要: |
| 目的 探讨女性早期尿道口恶性肿瘤保膀胱控尿性前尿道切除术后前尿道缺失采用会阴环形皮瓣一期吻合的可行性及有效性。方法 纳入2013年1月至2016年1月第二军医大学长海医院女性尿道口早期恶性肿瘤患者29例；术前患者平均年龄（61.4±14.4）岁，临床分期均为Ⅰ期，病变局限于前尿道的一半以内。行保膀胱控尿性前尿道切除术，肿瘤切除后，自会阴前庭向周围游离环皮瓣约30~40 mm长，与尿道近心残端内嵌式端端吻合。评估其临床可行性及安全性。结果 手术时间0.45~1.50 h，平均（0.51±0.30）h。患者术后尿道口形状接近生理结构，排尿通畅，最大尿流率12.8~33.0 mL/s，平均（19.3±8.7）mL/s。一期成功率为100%，无尿道狭窄、尿失禁。随访12~48个月，平均（32.6±3.5）个月。1例鳞癌患者一期手术后2年出现左侧腹股沟淋巴结转移，术后3年肺部广泛转移死亡；1例鳞癌患者术后13个月腹股沟局部淋巴结肿大，给予髂腹股沟淋巴结清扫，术后病理报告为转移性鳞癌。其余患者随访期间均未见复发。结论 对女性早期尿道口恶性肿瘤保膀胱控尿性前尿道切除术后前尿道缺失采用会阴环形皮瓣一期吻合手术成功率高，安全有效。 |
| 关键词: 尿道肿瘤 尿道口癌 会阴环形皮瓣 一期吻合 女性 |
| DOI：10.16781/j.0258-879x.2017.04.0511 |
| 投稿时间：2017-03-02修订日期：2017-03-14 |
| 基金项目: |
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| Application of perineal ring-shaped flap at first stage anastomosis in treatment of urinary continence anterior urethral defect in female patients with urethral carcinoma |
| LI Hui-zhen,LIU Zhi-yong,WANG Lei,CHENG Xin,XU Chuan-liang,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the feasibility and efficacy of the first stage anastomosis using perineal ring-shaped flap in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma. Methods Tweenty-nine female patients with early urethra malignant tumor diagnosed in Changhai Hospital, Second Military Medical University from Jan. 2013 to Jan. 2016 were enrolled in this study. The average age of the patients was (61.4±14.4) years old, the clinical stages were type Ⅰ and the lesions were limited to half of the urethra. All patients underwent bladder-preserving urinary continence anterior urethral resection. After the resection of tumor, a free 30-40 mm long ring-shaped flap from the perineal vestibule was anastomosed inline to the end of the urethra. The clinical feasibility and safety of the operation were evaluated. Results The operation time was 0.45-1.50 h, with an average of (0.51±0.30) h. The postoperative urethral orifice shape of patients was close to the physiological shape with unobstructed urination, and the maximum urination rate was 12.8-33.0 mL/s, with an average of (19.3±8.7) mL/s. The success rate of one-stage operation was 100%, without any urethral stricture or urinary incontinence. All patients were followed up for 12-48 months with an average of (32.6±3.5) months. During follow-up, 1 case (1/6) with squamous cell carcinoma had a positive left inguinal lymph node metastasis in the first 2 years after surgery, and died of extensive lung metastasis 3 years after surgery; 1 case diagnosed with metastatic squamous cell carcinoma by postoperative pathological report developed regional swollen lymph nodes in the groin 13 months after surgery, and then ilioinguinal lymphadenectomy was perform to dissect the lymph nodes. No other recurrence was found during follow-up. Conclusion The first stage anastomosis surgury using perineal ring-shaped flap is safe and effective in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma. |
| Key words: urethral neoplasms anterior urethra carcinoma perineal ring-shaped flap first stage anastomosis female |
