LOOP CYSTOURETHRAL CATHET''ERIZATION IN POSTERIOR URETHRAL TRAUMATIC STRICTURE

A safe and reliable method of postoperative urethral sounding for the treatment of traumatic stricture of the posterior urethra is described. When the urethral catheter and suprapubic tube are being removed, a plastic tube is introduced into the urethra and bladder with one end lead- ing out through the suprapubic wound and the other through the external urethral meatus and the 2 ends are fixed together to form a loop to prevent slipping. When urethral sounding is to be performed, the loop is opened and a filiform bougie is inserted firmly into the urethral end of the plastic tube. Guided by the bougie, the metallic follower can be put in without diffi- culty. So far no significant complications have been observed.     

TRANSPUBIC URETHROPLASTY COMBINED WITH PEDICLED-MUSCLE-FLAP GRAFTING IN THE TRE.ATMENT OF POSTERIOR MEMBRANOUS URETHRAL STRICTURES

Five cases of posterior urethral stricture were treated by a combination of transpubic urethroplas- ty and pedicled-muscle-flap grafting with m. rectus abdominis. All patients had a history of pelvic frac- ture or local trauma, and had had an operation with unfavorable results. Follow up of 7-25 months showed that all of them resumed normal voiding with normalization of urethrogram. No orthopedic problems and incisional hernia were observed.     

膀胱尿道环形管在治疗男性后尿道损伤和狭窄中的应用

目的探讨应用膀胱尿道环形管治疗男性后尿道断裂和狭窄手术的效果.方法对62例后尿道断裂者行尿道会师牵引术,79例创伤性后尿道狭窄者行开放性尿道成形术,术后用细塑料管、血管造影用导丝套管或输尿管导管作环形管,在环形管和丝状探条引导下用24号金属跟随器定期扩张尿道,扩张间期1个月,尿流正常,拔除环形管.结果124例(87.9%)获得随访,尿道会师牵引术治愈率94.6%,各种尿道成形术治愈率92.6%,带管扩张期间未发生新的尿道损伤.19例带管期间有尿道刺激症状,其中塑料管组9例(13.8%),套管组1例(4.2%),输尿管导管组7例(20.0%).结论环形管引导下尿道扩张避免了尿道扩张的盲目性,能巩固和提高尿道会师牵引术和尿道成形术的疗效.血管造影用导丝套管是较为适宜的环形管.     

FREE GRAFT TWO-STAGE URETHROPLASTY FOR HYPOSPADIAS REPAIR

Objective To evaluate the effectiveness of free graft transplantation two-stage urethroplasty for hypospadias repair. Methods Fifty-eight cases with different types ofhypospadias including 10 subcoronal, 36 penile shaft, 9 serotal, and 3 perineal were treated with free full-thickness skin graft or (and) buccal mucosal graft transplantation two-stage urethroplasty. Of 58 cases, 45 were new cases, 13 had history of previous failed surgeries. Operative procedure included two stages: the first stage is to correct penile curvature (chordee), prepare transplanting bed, harvest and prepare full-thickness skin graft, buccal mucosal graft, and perform graft transplantation. The second stage is to complete urethroplasty and glanuloplasty. After the first stage operation, 56 of 58 cases (96.6%) were successful with grafts healing well, another 2 foreskin grafts got gangrened. After the second stage operation on 56 cases, 5 cases failed with newly formed urethras opened due to infection, 8 cases had fistulas, 43 (76.8%) cases healed well. Conclusions Free graft transplantation two-stage urethroplasty for hypospadias repair is a kind of effective treatment with broad indication, comparatively high success rate, less complications.and good cosmatic results, indicative of various types of hypospadias repair.     

自制尿道吻合器治疗外伤性后尿道狭窄14例报告

应用自制尿道吻合器,治疗外伤性后尿道狭窄14例。获得随访9例,除1例失败外均获得成功。该器械有以下主要优点:①能较迅速、准确地切除瘢痕,比传统方法省时、省力,所作隧道整齐。②切除瘢痕同时,对后尿道粘膜进行一定程度分离,为吻合提供方便。③吻合器能在狭小术野操作,较理想地完成后尿道吻合。④不需切开膀胱,利用会阴部一个切口即可完成手术。     

经尿道球囊扩张治疗男性尿道狭窄16例报告

目的评价经尿道气囊扩张治疗尿道狭窄的疗效.方法电视监视下采用硬质超滑气囊扩张管治疗尿道狭窄16例.结果16例中有10例1次扩成功,4例经再次扩张成功,效果满意,扩张治疗成功的14例,随访2～36月,排尿通畅,无并发症.2例失败行开放手术.结论气囊扩张可以治疗单纯性尿道狭窄,具有创伤小、操作时间短、疗效可靠、并发症少等优点.     

阶梯式留置尿道支架管治疗尿道下裂术后尿道狭窄病儿的效果

目的 探讨阶梯式留置尿道支架管治疗尿道下裂术后尿道狭窄的效果.方法 对2000-2010年82例尿道下裂术后尿道狭窄病儿在进行尿道扩张同时阶梯式留置尿道支架管,观察治疗的效果.结果 82例病儿治愈69例(85%),其余13例再次行狭窄段切开尿道成形术.结论 在进行尿道扩张同时阶梯式增加留置尿道支架管的管径治疗尿道狭窄早期效果满意,术后6个月以上经上述方法扩张失败者则应行狭窄段尿道切开尿道成形术.     

窥视下尿道内冷刀切开加接触式激光治疗尿道狭窄

目的 评价尿道内冷刀切开加接触式激光治疗尿道狭窄的效果。方法 对27例尿道狭窄进行尿道内冷刀切开加接触式激光进行治疗。结果 24例病人术后排尿满意,另3例尿道狭窄复发,再行开放手术。结论 应用冷刀行尿道内切开加接触式激光治疗尿道狭窄,手术操作简单、安全、痛苦小、效果确切、出血少、比单独应用冷刀内切开或接触式激光治疗尿道狭窄效果好,复发率低。     

阴囊中隔带血管蒂皮瓣尿道下裂一期成形术

目的：探讨采用阴囊中隔带血管蒂皮瓣尿道下裂一期修复术的方法及疗效。方法：采用阴囊中隔带血管蒂皮瓣一期修复尿道下裂。Ⅴ型切除阴茎头尿道沟部分海棉体组织，成形尿道外口，仅留置导尿管引流尿液，滚动式挤压排出尿道内分泌物。结果：除l例尿道外口狭窄，3例尿道外，其它均排尿通畅，且经l-5年随访，无尿石形成及毛发生长。结论；该术式成功率较高。减少了尿道外口狭窄的可能，较适合阴茎阴囊型尿道下裂患者。     

SNODGRASS尿道成形术治疗先天性尿道下裂效果

目的 探讨应用SNODGRASS尿道成形术治疗先天性尿道下裂的效果.方法 对2003～2007年我院应用SNODGRASS尿道成形术治疗的先天性尿道下裂病儿42例的临床资料进行回顾分析,其中冠状沟型30例,阴茎体型12例.本组34例病儿术前无阴茎下弯,6例有轻度下弯,2例明显下弯.结果 术后随访6～30个月,42例中治愈36例(90%),阴茎伸直,外形美观,尿道口开口正位,排尿通畅.术后并发尿道瘘6例,均修补成功.结论 SNODGRASS尿道成形术治疗阴茎尿道下裂操作简单,手术时间短,术后外形效果好,并发症少.     

气囊U管粘膜移植术治疗胆道损伤性狭窄

在欧美广泛应用Smith式粘膜移植法处理医源性损伤后的胆道狭窄,但术后部分病人仍可出现再狭窄。作者时Smith法加以改进,定名为“气囊U管粘膜移植法”。其特点是:①肠粘膜的开口与肝管的口径相同;②使用U管;③在U管上附加一只气囊以防止肠漏及胆漏,又可在适当时拉入胆道,对吻合口进行扩张。临床使用效果良好,是一种简易有效而安全的方法。     

带血管蒂游离髂骨移植治疗长骨干骨折不连接

报告了吻合血管的游离髂骨移植治疗长骨干骨折不连接,桡骨1例,胫骨4例。骨不连接的时间为14～42个月。术后4～6周X线片均示有不同程度骨痂生长,10～14周完全骨性愈合。介绍了手术操作,通过临床应用与传统的植骨相比,明显的缩短了疗程并提高了治愈率。     

二期尿道吻合术治疗尿道损伤51例

本文报告了二期尿道吻合术治疗尿道损伤51例,近、远期疗效均好。尿道损伤早期,膀胱造瘘,三月后行二期尿道吻合术,是治疗尿道损伤、减少并发症较好的方法。     

骨盆骨折并膀胱、尿道损伤的护理对策

目的：探讨骨盆骨折并膀胱、尿道损伤患者的临床特点及护理对策。方法回顾分析27例骨盆骨折并膀胱、尿道损伤患者的临床、护理资料。结果27例患者中合并膀胱损伤9例,男性尿道损伤18例;24例患者行相关手术治疗;因失血性休克死亡1例,3例合并尿道损伤患者出现尿道狭窄定期行尿道扩张术,余23例患者均顺利康复出院无远期并发症发生。结论个体化的综合护理方案,可以提高骨盆骨折并膀胱、尿道损伤患者的治愈率,减少并发症的发生。     

尿道成形术中尿道支架管内置管膀胱引流的护理

目的 探讨尿道成形术中尿道支架管内王管膀胱引流的护理要点.方法 对44例尿道下裂患者管道护理,切口的观察、并发症及健康教育的总结.结果 44例中术后36例愈合,尿瘘8例,并发症发生率18.18%.结论 尿道下裂手术难度大,术后护理要求高.保证引流管道的通畅,减少瘢痕是增加手术成功丰,减轻患儿心理影响,提高远期疗效的重要保证.     

腱鞘移植在严重腱周组织损伤中肌腱修复的应用

为探索屈指肌腱鞘背侧重建技术的屈指肌腱修复效果。对24例屈指肌腱Ⅱ区损伤手指,运用游离腱鞘移植修复其屈指腱背侧腱鞘。游离腱鞘取自同侧手腕背第一间隔。屈指腱鞘背侧重建技术用于早期或延迟早期屈指肌腱损伤、二期肌腱移植修复和肌腱粘连松解术时有骨面裸露或挫伤者。根据Strickland评价标准,结果优7指,良11指,中5指,差1指,优良率为75％。用游离自体移植腱鞘重建背侧屈指腱鞘,是提高严重腱周组织损伤的肌腱修复的一种有效方法。     

颈椎后路一次性手术治疗颈椎管狭窄合并颈椎间盘突出

目的探讨颈椎管狭窄合并颈椎间突出一次性后路减压和髓核摘除的手术方法以及手术时应注意的问题。方法 :经颈椎后路摘除椎间盘 38例。局麻、俯卧位 ,颈椎后路单开门椎管扩大成形后 ,以病变间隙为中心 ,纵行切开硬脊膜 ,根据需要切断病变侧 2～ 3条齿状韧带 ,将脊髓轻轻向中线牵拉 ,摘除突出的髓核。结果 :38例中 35例获得平均 3年 2个月 (6个月～ 7年 10个月 )的随访 ,优 2 1例 ,良 11例 ,有效 3例 ,避免前、后路 2次手术 ,效果满意 ,但应选择好手术适应证 ,手术操作时应注意对脊髓和神经根的牵拉以及对齿状韧带与神经根的辨认等问题。     

宫颈癌放射治疗远期疗效的临床研究

目的：明确宫颈癌单纯放疗时低、高剂量率近距离治疗、外照射中线挡铅与否的远期疗效和放射性损伤,指导宫颈癌放射治疗技术改进。方法：回顾性分析了240例Ⅰ～Ⅲ期宫颈癌的放射治疗后的长期随访结果,比较低、高剂量率后装治疗和盆腔大野中线挡铅与否的疗效和副作用。结果：全组随访时间为13～16a,中位随访时间14.6a,随访率90%。10a总生存率为69.17%。Ⅰ期10a生存率100%,Ⅱ期83.05%,Ⅲ期46%。低剂量率组10a生存率Ⅰ期是100%,Ⅱ期64.71%,Ⅲ期42.86%。高剂量率组10a生存率是Ⅰ期92.31%,Ⅱ期62.69%,Ⅲ期41.38%。低、高剂量率组Ⅰ期中线挡铅与不挡铅的10a生存率分别为100%、100%和100%、100%;Ⅱ期的10a生存率分别是64.52%、65%和63.89%、61.29%。Ⅲ期的10a生存率分别是40%、45.45%和43.33%、39.29%。经过显著性检验,P〉0.05。本组3、4级放射性直肠炎总发生率为13.13%,其余均为1、2级放射性直肠炎,挡铅组的副反应较轻。放射性膀胱炎发生率为8.8%,多为1、2级。结论：低、高剂量率近距离治疗的疗效均较好,后者较前者具有较多的优越性,建议推广使用高剂量率近距离治疗,对经济状况不好的病人,可以采用盆腔大野照射,但应降低近距离照射的剂量。     

ONE STAGE BLADDER MUCOSA FLAP URETHROPLASTY FOR HYPOSPADIAS REPAIR

Bladder mucosa flap urethroplasty, a one stage operation for hypospadias repair, is des- cribed. Of 110 cases of congenital hypospadias treated by this procedure, 105 (95.5To)' were suc- cessful. It is indicated for several types of hypospadias and has few complications. For cases with intractable urethral stenosis, the pro- cedure should be preceded by urethrotomy 6 months previously.