22例直肠阴道瘘的个体化手术方式选择的治疗经验

目的 探讨直肠阴道瘘的手术治疗经验。方法 将22例直肠阴道瘘分为高位瘘、中低位瘘和复发瘘,而分别采用经肛门结肠拖下术,直肠粘膜游离瓣修补术和经会阴体瘘管切除直肠阴道修复术。结果 22例患者均获痊愈。无需结肠造瘘。随访1～11年,无复发。结论 直肠阴道瘘形式复杂,个体化手术方式的正确选择、恰当的手术时机、充分的术前准备以及加强术后管理是手术成败的关键。     

腹腔镜下膀胱阴道瘘修补术16例临床经验

目的 探讨腹腔镜下膀胱阴道瘘（vesicovaginal fistula,VVF）手术方法的可行性并评价及其疗效。方法 回顾性分析2019年8月至2022年10月青岛大学附属医院收治的16例VVF患者的临床资料,包括病因、手术方法、围术期护理及疗效等。记录手术时间、术中出血量及住院时间,对手术方法及治疗效果进行分析总结。术后随访6～12个月,随访患者是否漏尿及生活质量改变等情况。结果 16例患者行经腹腔镜下膀胱阴道瘘修补术,成功15例（包括宫颈癌术后放疗患者3例）,未成功1例术后1个月再次行手术治疗后修补成功。手术时间（86.56±18.66） min,术中出血量（24.06±21.39） ml,住院时间（14.31±4.56） d,随访（9.50±1.55）个月,患者术后生活质量明显改善。结论 VVF手术方法的选择主要取决于医师的经验及患者的身体情况,腹腔镜下修补VVF具有创伤小、恢复快及成功率高等优点,是治疗VVF安全有效的手术方法。     

经阴道修补直肠阴道瘘的临床分析

为探讨经阴道修补治疗直肠阴道瘘的临床效果，回顾分析于我院经阴道修补治疗的5例直肠阴道瘘患者的病例资料。结果显示，5例患者均成功完成手术，其中1例术后1个月内有少量阴道排气，2个月后痊愈。随访6个月至5年，均无复发。结果表明，准确把握手术时机、适应症及全面的围手术期护理，是经阴道修补直肠阴道瘘手术成功的关键。     

复发性卵巢子宫内膜异位囊肿32例分析

目的探讨卵巢子宫内膜异位囊肿术后复发二次手术的可行性、治疗的适应证、手术途径与方式。方法回顾分析32例复发性卵巢子宫内膜异位囊肿复发情况，二次手术途径与方式，术后随访情况。结果32例患者均进行了二次手术，28例开腹手术，3例为腹腔镜手术，1例中转开腹。结论二次手术治疗应结合临床症状及妇科检查、影像学情况及生育要求进行综合评价，充分做好术前准备，选用个体化治疗方案，应选择能尽量彻底清除病灶的术式。     

宫颈癌根治术同期行阴道延长术患者的围术期护理

对31例宫颈癌患者实施根治术同期行腹膜代阴道延长术.结果 手术过程顺利,术后9～11 d出院,无并发症发生.术后3～6个月返院复查和问卷随访,无1例发生阴道挛缩或粘连;28例恢复正常性生活.提示术前给予心理护理及积极的胃肠道准备,术后加强会阴护理,做好阴道模具的使用和消毒,密切观察病情,给予详细的出院指导,能减少手术并发症并有助于改善患者术后性生活质量.     

经腹径路手术治疗膀胱阴道瘘的临床分析

目的:探讨经腹径路手术治疗膀胱阴道瘘的临床疗效。方法:回顾性分析14例女性膀胱阴道瘘患者资料。患者平均年龄41.36岁。临床表现不同程度阴道漏尿,或伴血尿及膀胱刺激症状。膀胱镜检、膀胱尿道造影及CT三维重建术前确诊。先后行经腹径路膀胱阴道瘘修复手术,其中采取经膀胱径路9例,膀胱外径路5例。结果:14例术后随访9～103个月,平均46.26个月。2例术后出现再次膀胱阴道瘘,行二次修补手术后未再复发,1例出现切口感染,经对症处理后愈合,其余患者均未出现尿瘘复发及其他严重并发症。结论:经腹径路手术治疗膀胱阴道瘘,术中视野暴露充分,易于获取带蒂支持组织,尤其对于复杂性膀胱阴道瘘及合并输尿管等组织损伤可疑患者,是一种可行的手术治疗方式。     

宫颈癌根治术同期行阴道延长术患者的围术期护理

对31例宫颈癌患者实施根治术同期行腹膜代阴道延长术。结果手术过程顺利，术后9～11d出院，无并发症发生。术后3～6个月返院复查和问卷随访，无1例发生阴道挛缩或粘连；28例恢复正常性生活。提示术前给予心理护理及积极的胃肠道准备，术后加强会阴护理，做好阴道模具的使用和消毒，密切观察病情，给予详细的出院指导，能减少手术并发症并有助于改善患者术后性生活质量。     

直肠阴道瘘的病因分析和临床对策

目的　探讨直肠阴道瘘的形成原因和临床对策。方法　回顾分析我院 1993～ 2 0 0 3年直肠阴道瘘患者 2 1例临床资料。结果　先天性直肠阴道瘘 12例行肛门成行术 ,患者均获痊愈 ,后天性直肠阴道瘘 9例采用不同修补式治疗 ,除复发 2例经再次手术治愈外 ,其余瘘均一期愈合。随访 1～ 9年 ,无复发。结论　直肠阴道瘘形成原因复杂 ,选择恰当的术式和手术时机、充分的术前准备以及加强术后管理是手术成败的关键。     

低位直肠癌保肛术后肿瘤复发的治疗

目的探讨低位直肠癌保肛术后复发的治疗方法及预后。方法回顾性分析了47例低位直肠癌保肛术后复发患者的临床及随访资料。结果22例复发患者接受了新辅助治疗．其中3例复发病灶不同程度降期．11例复发病灶明显缩小．总有效率达63．6％。31例复发患者行再次切除手术．其中根治性切除16例，姑息性切除15例：16例未行切除手术．其中单纯造瘘者11例．单纯放疗或化疗者4例，另1例未予任何治疗。根治性切除术组3年、5年生存率分别为42．3％和22．6％，姑息性切除术组3年、5年存活率分别为23．6％和11．8％。单纯造瘘和单纯放化疗者术后中位生存时间分别为12．6个月和8．5个月．1例未予治疗者仅存活6个月．结论低位直肠癌术后复发者仍应积极行根治性手术．术前行新辅助治疗。可提高再次手术成功率；对于无法再次根治性切除的患者．通过减瘤手术或造瘘术．也可以延长部分患者的生存期．改善患者生活质量。     

生物补片修补术治疗中低位直肠阴道瘘临床疗效观察（附10例报告）

目的评价生物补片修补术治疗中低位直肠阴道瘘的疗效,探讨该术式的可行性。方法10例直肠阴道瘘患者,其中先天发育不良6例,肛门直肠周围脓肿2例,外伤1例,产伤1例。10例患者采用经阴道入路,将直肠阴道壁的缺损部分在无张力状态下应用生物补片包埋缝合修补。观察术后阴道漏气漏便、补片与组织排斥反应、补片的溶合降解、创面愈合时间、肛门功能等情况,并对患者进行随访。结果10例患者经一次手术治愈,随访2年,未出现复发现象。结论对于中下段单纯性直肠阴道瘘,经阴道行生物补片修补术治疗是一种安全、有效、可行的手术方法。     

Total Colpectomy Increases the Risk of Postoperative Hydronephrosis in Vaginal Cancer Patients

ABSTRACT

Purpose: Due to the rarity of vaginal cancer, surgical treatment results, and postoperative complications have been poorly described in the literature. The aim of this study was to improve current knowledge about the incidence of hydronephrosis following the surgical treatment of vaginal cancer. Materials and methods: 32 patients with vaginal cancer of the middle and upper third were matched with 32 cervical cancer patients (stages I and II) for comparison of long-term urological postoperative complications. All patients underwent radical surgical treatment and all stage II patients underwent neoadjuvant radiotherapy. Results: Hydronephrosis had a significantly higher incidence in the vaginal cancer group (p = 0.04), with 14 patients (43.8%) being diagnosed with this complication compared to only 5 patients (15.6%) in the cervical cancer group. Among patients that received radiotherapy, 40.1% (n = 9) and 22.7% ( = 5) of vaginal, respectively cervical cancer patients were found with postoperative hydronephrosis. Conclusions: In vaginal cancer patients total colpectomy increases the risk of developing postoperative hydronephrosis, especially if neoadjuvant radiotherapy has been applied.     

Vaginoplasty with Acellular Dermal Matrix after Radical Resection for Carcinoma of the Uterine Cervix

Various methods are available for vaginoplasty, but many of them have the drawbacks including surgical complexity and postoperative pain at the donor site. We herein evaluated the outcomes of vaginoplasty using tissue-engineered biomaterial graft. This study included 16 early stage cervical cancer patients who received curative surgery in combination with radiotherapy. They underwent vaginoplasty with tissue-engineered biological material, acellular dermal matrix (ADM). After treatment, a vaginal dilator was advised to be used for 6 months to prevent contraction of vagina. The effectiveness of the treatment was evaluated by the anatomic changes of vagina before and after treatment, and the sexual outcomes at 12-month after treatment. The procedure was safe with no intra-operative complications reported. The mean operation time was 1.7 ± 0.3 hours, with 11/16 patients had blood loss < 50 mL during surgery. Generally, epithelialization was observed in 2-week after treatment. At the 1-year follow-up visit, the mean vaginal width was increased significantly from 1.31 ± 0.4 cm before surgery to 4.13 ± 0.43 cm after surgery (p = 0.034). The vaginal length was also increased from 5.97 ± 0.59 cm to 9.25 ± 0.66 cm (p < 0.001). Majority of the patients (12/16) reported satisfactory sexual life. The use of ADM in vaginoplasty was a safe and effective procedure that provided satisfactory sexual function for patients with vaginal abnormalities after cervical cancer treatment.     

Quality of life after free-flap reconstruction in patients with oral and pharyngeal cancer

BACKGROUND: Our aim was to investigate quality of life and outcome after microvascular free-flap reconstruction after oncologic surgery. METHODS: Forty-four patients with a large carcinoma in the oral cavity, oral pharynx, or hypopharynx underwent free-flap surgery with or without radiotherapy. Patients completed the University of Washington Quality-of-Life Questionnaire preoperatively and four times during the 12 postoperative months. Survival rates and complications were analyzed. RESULTS: Postoperative composite quality-of-life scores were significantly lower than before treatment with no significant overall improvement during the follow-up. The scores for disfigurement, chewing, speech, and shoulder function remained significantly below the preoperative level throughout the follow-up. Sociodemographic factors predicted quality of life. Heavy drinking and unemployment caused a 2.4-fold and a 4.4-fold increase in risk of death, respectively. The rates for overall survival, tumor recurrence, flap success, and surgical complications were consistent with previous literature. CONCLUSION: Sociodemographic variables affect quality of life and patient survival in patients with oral cancer treated with microvascular free-flap reconstruction.     

Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision

Anterior resection and abdomino-perineal resection are the surgical techniques used most frequently in the treatment of rectal cancer. Local recurrence rates of 10% to 14% are described after these conventional procedures. Preoperative neoadjuvant radiotherapy reduces local failure. Because local excision techniques can be applied to treat early rectal cancer in selected patients, we evaluated the results of preoperative high-dose radiotherapy and transanal endoscopic microsurgical excision (TEM) in patients with T2 rectal cancer. All patients underwent preoperative irradiation with 5,040 cGy, divided over 5 weeks. Forty days after completion of radiotherapy, the patients underwent complete full-thickness local excision of the rectal lesion including adjacent perirectal fat by TEM. The patients were followed for up to 8 years. Thirty-five patients, with pT2 rectal cancer as determined by pathological examination of the surgical specimen were enrolled in the present study. The tumors were responsive to preoperative radiotherapy in 82.8% of cases. No intraoperative complications and no conversion to open surgery were observed. No major complications and no mortality occurred during the 60-day postoperative period. Minor postoperative complications were observed in 5 patients (14.3%). The median follow-up of the patients was 38 months (range 24 to 96 months). One local recurrence (2.85%) was noted. The probability of surviving at 96 months after completion of treatment was 83%. Local excision by TEM combined with preoperative high-dose radiotherapy can achieve results similar to those observed after conventional surgery in patients with pT2 rectal cancer.     

The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas

OBJECTIVE: Radiotherapy after aggressive surgical resection of nonfunctional macroadenoma (NFA) of the pituitary remains controversial. Historically, immediate postoperative radiotherapy has been recommended to decrease risk of recurrence. With the availability of high-resolution imaging, most neurosurgeons now withhold radiation until recurrence. There is relatively little evidence to support this practice, however. This study reviews postoperative results in a large number of patients with NFA, the majority of whom did not undergo prophylactic radiation. METHODS: Of the 258 patients who underwent surgery from 1979 to 1999 for NFA, medical records were available for 176. Forty-four patients were treated with immediate postoperative radiotherapy after tumor resection, and the remaining 132 patients were followed up with serial imaging studies and treated with radiotherapy only when a recurrence was documented by follow-up imaging. RESULTS: Patients in the group that received immediate postoperative radiotherapy at time of initial diagnosis and surgery did not differ significantly with respect to age or sex from those in the group that was observed. Five- and 10-year recurrence rates were 2.3 and 2.3%, respectively, for patients who received immediate postoperative radiotherapy, as compared with 15.2 and 50.5%, respectively, for patients who were followed up and did not receive radiotherapy unless there was evidence of recurrence or progression. No patient had symptomatic recurrence in the group that was observed if consistent follow-up was performed. Of the 26 patients who received radiotherapy at time of tumor recurrence or progression, 18 had adequate follow-up, and in all cases, the tumors either remained stable or regressed. CONCLUSION: Withholding radiotherapy after a high-percentage resection of NFA leads to a higher recurrence rate, but it avoids exposing all patients to the risks of radiation. Deferring radiotherapy for patients with complete or near-complete resection seems to be a safe and prudent approach, as our data suggest that recurrences may be detected early with high-resolution imaging and treated effectively with radiation at time of recurrence. Therefore, immediate postoperative radiotherapy may be eliminated for patients with complete or near complete resection of NFA and who agree to undergo close follow-up for a long period.     

Laparoscopy-assisted transvaginal total exenteration for locally advanced cervical cancer with bladder invasion after radiotherapy

When invasive cervical cancer involves the urinary bladder or rectum, exenteration can be curative treatment. However, this operation, particularly by an open approach, carries significant morbidity, both physically and psychologically. Laparoscopic surgery has been documented to be a reasonable alternative to the open counterpart for a variety of pelvic operative procedures, including such advanced procedures as laparoscopy-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and laparoscopy radical hysterectomy. With improving surgical technology and increasing surgical experience, exenteration is a logical extension of current laparoscopic practice. However, it raises skepticism regarding the feasibility and justification for the complicated surgery. We herein describe our experience in a patient undergoing total exenteration assisted by laparoscopic technology for advanced recurrent cervical cancer after extensive radiotherapy. Transperitoneal laparoscopic total exenteration with ureterosigmoidstomy and end-sigmoidostomy was accomplished in 6 hours. The whole specimen was removed en bloc transvaginally. The patient tolerated the procedure well. The only complication was a wound infection 50 days postoperatively that was controlled with debridement and antibiotics. No episodes of pyelonephritis occurred. After 1 year of follow-up, the patient is free of cancer by imaging studies and lives without associated morbidity of this extensive palliative operation except the care of the sigmoid colostomy.     

腹壁韧带样瘤六例诊治分析及文献复习

目的探讨腹壁韧带样瘤的诊断和治疗。方法回顾性分析攀钢集团总医院1999年3月至2015年1月收治的6例腹壁韧带样瘤病人的临床资料。病人以腹部包块入院,无特异性的临床表现。治疗上均选择以手术治疗为主,术中保留皮肤及皮下组织,沿肿瘤边缘完整游离肿瘤,距离肿瘤边缘大于2 cm完整切除肿瘤,将切除的肿瘤送冰冻病理检查,若切除的肿瘤边缘为阳性,则继续扩大切除范围。手术后若腹壁缺损较大,则用补片予以修补,术后予以放疗。结果 6例病人中女性5例,均为经产妇,1例为男性;均因为发现腹壁包块入院就诊,术前经过彩超或CT检查证实肿块位于腹壁,肿瘤最长径在2.7~7.9 cm之间,平均为5.6 cm。6例病人均经手术广泛切除治疗,其中2例接受术后放疗。术后随访7~361个月,复发者1例(未接受术后放疗),复发率为16.67%。结论腹壁韧带样瘤为临床少发疾病,发展缓慢,无特异性临床表现,以女性好发,治疗上以外科手术为主,术后放疗可降低复发率。     

Benign tumors of the parotid gland: a retrospective study of 339 patients

Aim: Among 339 patients operated for benign tumor of the parotid gland: the recurrences and the postoperative complications rates were compared WITH those published in literature.

Materials and methods: About 339 patients operated: 274 primarily and 65 for recurrence or residual tumor. Variables: sex, age, surgical techniques, pre- or postoperative radiotherapy, histology, size and localization of the tumors, disease free intervals, recurrences and postoperative complications.

Results: 177 men and 162 women. Median age: 55 years and mean follow-up: 10.4 years. About 39 patients had adjuvant radiotherapy (11.5%). After primary surgery, four patients experienced recurrences (1.5%). After salvage surgery, eight patients recurred (12.3%). The recurrence rate was the highest among pleomorphic adenomas. Facial paralysis was more frequent after salvage surgery.

Discussion: Recurrence rate 10 years later was lower after primary than after salvage surgery (p?=?0.01). There was no relation between adjuvant radiotherapy and recurrence rate probably because the low rate of recurrences.

Conclusion: Recurrence rate after primary surgery is lower after superficial or total parotidectomy than after other surgical techniques. Pleomorphic adenomas have the highest rate of recurrences. Age and sex have no significant influence over the rate of recurrences. The most frequent postoperative complications are facial paralysis and Frey’s syndrome.     

Treatment of craniopharyngiomas in children

PURPOSE: The purpose of this article is to assess, in a 25-year retrospective study, the clinical outcome in children with craniopharyngioma. PATIENT AND METHODS: From 1978 to 2002, 12 children younger than 15-year-old underwent treatment with surgery and/or radiotherapy for craniopharyngioma. The clinical course and outcome were reviewed. RESULTS: The median age was 7.3 years (range, 3 to 12 years) at the time of initial surgical resection. With a mean follow-up period of 132 months (range, 29 to 255 months), 1 patient died of tumor progression due to malignant transformation at 205 months after the initial surgery and the overall outcome was good in 11 patients. Out of 12 patients 4 presented a recurrence of their tumor, 2 after an apparently gross total removal. Because of tumor recurrence, 2 received conventional radiation therapy and 3 received gamma knife radiosurgery. There was neither operative mortality nor major complication. All patients required hormonal replacement postoperatively. CONCLUSIONS: The goal in the treatment of craniopharyngiomas is to achieve total removal without morbidity. Our results compared favorably with the previous reports in the literature. MRI follow-up should be performed even in patients whose primary tumor is resected "completely". Suitable combination of open surgery, conventional radiotherapy and gamma knife radiosurgery may result in optimal functional outcome. Recovery from postoperative pituitary dysfunction can be occasionally expected.     

腹腔镜治疗宫颈癌术后输尿管阴道瘘的临床体会

目的探讨腹腔镜乳头式输尿管膀胱再植及腹腔镜膀胱肌瓣管输尿管成形术治疗对于保守治疗无效的宫颈癌手术及放疗所致输尿管阴道瘘患者的手术效果及临床价值。方法回顾性分析2014年1月至2018年11月徐州医科大学附属医院泌尿外科诊治的15例在外院或我院试行输尿管支架管置入失败的输尿管阴道瘘患者,15例患者均行CT尿路成像、膀胱镜等检查确诊,其中13例行腹腔镜下乳头式输尿管膀胱再植术,另2例因输尿管下段粘连较重无法分离而改行腹腔镜膀胱肌瓣管输尿管成形术,观察指标包括手术时间、出血量及术后并发症。结果 15例患者均行腹腔镜手术成功,无一例改开放或失败,平均手术时间146(95~208)min,出血量110(60~180)ml,术后3个月拔出双J管,随访3~12个月,均未出现漏尿、进展性肾积水等严重并发症。结论腹腔镜手术治疗对于保守治疗无效的输尿管阴道瘘患者疗效确切、安全可靠,创伤小、出血少、恢复快、成功率高,可明显提高患者生活质量,值得临床推广,但需要娴熟的腹腔镜操作技巧及丰富的解剖学经验。