女性原发性尿道肿瘤的临床特点与诊治

作者总结了近２０年来收治的１４例女性原发性尿道肿瘤患者的诊治经验，分析了尿道癌、尿道平滑肌瘤及尿道纤维息肉的不同临床表现与局部特点，并指出尿道癌的肿瘤分期及预后与其病理类型密切相关。诊断方法主要采用阴道指诊、尿道镜检查、Ｂ超检查及活组织检查。诊断步骤推荐采用肿瘤定位－定性－分期三步法。治疗方法主要采用手术切除肿瘤，但选择尿道癌的手术方式时应依据肿瘤分期，并应充分考虑到患者术后的生活质量。     

女性尿道原发性恶性黑色素瘤3例报告

目的：探讨女性尿道原发性恶性黑色素瘤的临床特征及治疗手段。方法：对3例女性原发性尿道恶性黑色素瘤进行临床病理分析及随访观察。结果：3例均以尿道外口包块就诊。2例因术前诊断不清，仅局部切除，其中1例术后半年死于肿瘤复发。1例正在随访中；1例行全尿道切除，双侧腹股沟淋巴结清扫及永久性膀胱造瘘。结论：女性尿道原发性恶性黑色素瘤恶性度高，临床易误诊，早期确诊的主要依据是病理学检查，及时规范手术是提高患者生存率的主要手段。     

女性尿道原发性恶性黑色素瘤1例并文献复习

目的 结合文献资料复习,提高女性原发性尿道恶性黑色素瘤的诊疗水平.方法 回顾性分析1例女性原发性尿道恶性黑色素瘤患者临床资料.结果 病例行尿道癌根治术+回肠膀胱术,术后病理证实为尿道恶性黑色素瘤,浸及尿道全层及阴道浆膜面,阴道黏膜及肌层未见癌,膀胱、双侧附件、子宫体、宫颈未见癌,双侧盆腔淋巴结未见转移癌.已随访1年,...     

原发性女性尿道癌（附21例报告）

为探讨女性尿道癌的发病趋势及临床过程，治疗及预后，总结３０年来收治原发性女性尿道癌患者２１例，平均年龄４８．５岁。主要临床表现有尿道出血，尿道口新生物等。手术行尿道部分切除术，尿道全切膀胱肌瓣代尿道等。病理结果：腺癌１０例（４７．６％），鳞癌９例（４２．８％），移行细胞癌２例（９．５％）。提出肿瘤位置，侵犯范围，组织学特点和有无远处转移四点决定肿瘤治疗方案和预后。     

原发性女性尿道黑色素瘤(附4例报告)

目的　探讨女性尿道原发性恶性黑色素瘤的临床特征及治疗方法。方法　对4例女性原发性恶性黑色素瘤进行临床病理分析及随访观察。结果　4例患者均为尿道外口肿物就诊。2例因术前诊断不清,仅作局部切除,其中 1 例术后 16 个月死于肿瘤复发,1例仍在随访中;另2例行全尿道切除,双侧腹股沟淋巴结清扫及永久性膀胱造瘘。结论　女性尿道原发性黑色素瘤恶性度高,临床易误诊,早期诊断的主要依据是病理学探查,及时规范手术是提高患者生存率的主要方法。     

女性原发性尿道癌8例临床分析

目的探讨女性原发性尿道癌的临床特点、治疗及预后。方法回顾性分析2000年1月至2013年12月期间的8例女性原发性尿道癌患者资料并进行随访,了解其转移、复发和生存情况。采用Kaplan-Meier法进行生存分析。结果 8例尿道癌患者以老年女性为主,平均64岁。常见的临床表现为尿道外口肿物、排尿困难及肉眼血尿。尿路上皮癌为其主要病理类型。8例患者均行手术治疗,6例患者行术后辅助化疗。中位随访25.5个月,4例患者死亡,2例患者发生远处转移,2例患者无瘤生存。中位生存期31个月,1年生存率为75.0%,3年生存率为41.7%。结论女性原发性尿道癌是一种罕见且预后较差的恶性肿瘤,治疗方案以手术切除为主,对于晚期肿瘤多建议采取手术治疗、放化疗相结合的综合治疗方案。     

TUR术治疗原位新膀胱术后再发尿道癌

目的 探讨膀胱癌全膀胱切除原位新膀胱术后再发尿道癌的治疗方法.方法 膀胱癌行全膀胱切除原位新膀胱术患者89例,术后发生尿道癌5例(5.6%),再发尿道癌平均时间18(9～32)个月.5例患者病理分期为T1～T2.因复发性膀胱癌行全膀胱切除术4例,因膀胱多发癌行全膀胱切除术1例.采用乙状结肠原位新膀胱术3例,回肠原位新膀胱术2例.5例患者术后因排尿不畅(3例)、肉眼血尿(1例)、血性分泌物(1例)再次就诊.尿道镜检查发现尿道肿物位于前列腺部尿道2例、阴茎部尿道3例.肿物呈菜花状向尿道腔内生长,可见基底部,肿物直径1～3 cm.尿道镜活检报告均为尿道尿路上皮癌,病理分期为T1～T2.5例均行TUR术,术后病理报告为尿道非浸润性尿路上皮癌Ⅰ～Ⅱ级.术后辅以羟基喜树碱尿道灌注,每周1次,共6周.结果 5例TUR术后平均随访37(24～52)个月,控尿满意,血尿和血性分泌物均消失,尿细胞学检查均为阴性,尿道镜检查无阳性发现.肿瘤未见复发、转移.结论 膀胱癌膀胱全切术后再发尿道尿路上皮癌可以选择保全尿道的TUR术和尿道灌注治疗,疗效较满意且生活质量良好.     

膀胱癌根治性膀胱切除术后尿道癌复发的研究进展

膀胱移行细胞癌是泌尿系统最常见的肿瘤,根治性膀胱切除是治疗浸润性膀胱癌的主要手术方法。膀胱全切术后无论应用肠道原位膀胱替代还是尿液皮肤转向,均有可能发生尿道移行细胞癌。为了及早发现和提高对其治疗效果,本文就有关尿道癌复发的发生率、病因、临床表现、诊断和治疗等有关一些研究进展作一综述。     

应用膀胱三角区壁瓣成形尿道治疗女性外伤性尿道缺损(附5例报告)

目的：探讨膀胱三角区壁瓣成形尿道治疗女性外伤性尿道损伤的疗效。方法：自膀胱颈后唇向上，取梯字形壁瓣，形成锥状管，经膀胱颈口，自阴道前壁外拉至外阴部，在原尿道外口处固定，替代尿道。结果：3例随访8年，1例6年，1例5年，平均随访7年，均排尿通畅，无尿失禁和尿道狭窄。结论：女性外伤性尿道缺损，应用膀胱三角区壁瓣形成锥状管替代尿道法治疗，手术简单，对患者打击小，成功率高，远期效果好。     

前列腺增生并前列腺部尿道癌临床分析

目的探讨原发性前列腺部尿道癌的临床特征及治疗方法。方法对3例前列腺增生合并原发性前列腺部尿道癌患者的临床资料进行回顾性分析。结果 3例患者均表现为排尿不畅并膀胱刺激症状等,术中病理确认后,均行经尿道电切手术,切除肿瘤及前列腺增生组织,其中2例坚持膀胱灌注化疗,分别随访5年和3年6个月,未发现复发和转移,1例未行膀胱灌注化疗,术后10个月发现膀胱肿瘤。结论老年前列腺增生合并前列腺部尿道癌的患者,如肿瘤分级分化较好,行保留器官的肿瘤切除术,术后坚持膀胱灌注化疗,密切随访,是保证患者生活质量的有效治疗方法。     

Criteria of decision on the access for laparoscopic choledocholithotomy

The article presents an experience with operative treatment of 187 patients for choledocholithiasis using endovideosurgical technology. The conditions influencing the optimal choice of places for introduction of trocars responsible for maximal efficiency of the intervention were analyzed. Principal criteria of the operative access were established: the depth of operative procedure, distance between the xiphoid process and the place of introduction of the epigastral trocar, the angle of operative procedure, the angle of ascent.     

术后早期肠梗阻的临床特点与对策分析

目的　探讨术后早期肠梗阻的临床治疗对策与再手术时机。方法　总结 2 0例术后早期肠梗阻病人的临床治疗过程及对典型病例的具体分析。结果　用保守方法治疗 14例 ,12例痊愈。再次手术 6例 ,4例痊愈。结论　术后早期炎性肠梗阻和麻痹性肠梗阻应保守治疗 ,对机械性绞窄性肠梗阻应及时再次手术探查 ,才能解除梗阻 ,挽救生命     

经扩大的颅前窝底入路切除鼻蝶斜坡部位肿瘤

目的 通过手术入路和手术技术的改进以提高颅底中线部位肿瘤的手术治疗效果。方法 采用扩大的前颅底入路,对１５例颅底中线部浸及鼻、蝶、斜坡的肿瘤进行根治性切除。结果 肿瘤全切除１０例,近全切除４例,部分切除１例。术后恢复良好者１４例,经残１例。结论 采用这种入路和技术扩大了颅底中线部肿瘤的手术适应证,改善了手术效果,并且有适应范围广、显露良好、颅底重建可靠、可避免严重并发症等优点。     

腹腔镜与开腹Miles手术治疗低位直肠癌疗效的临床对照研究

目的：比较腹腔镜与传统开愎直肠癌Mikes手术的临床疗效。方法：对2002年2月至2007年5月行腹腔镜下直肠癌Miles术67例（A组）与开腹直肠癌Miles术35例（B组）患者的术前临床资料和术中失血量、淋巴结清扫数、手术时间、术后胃肠道功能恢复时间和自主排尿时间、术后住院时间、治疗费用、手术及总住院费用进行比较。结果：A组术中失血量、术后胃肠功能恢复时间和自主排尿时间及术后住院时间均小于B组,差异有统计学意义（P〈0．05）。手术时间、淋巴结清扫数、总住院费用无明显差异（P〉0.05）。结论：腹腔镜直肠癌Miles手术与开腹直肠癌Mlies手术相比,切除范围能达到开腹手术的水平,具有患者手术创伤小、出血量少、术后康复快且费用无明显差异等特点,可推广应用．     

Sugiura procedure outside Japan. The Mexican experience

In the last 10 years, we operated on 231 patients with hemorrhagic portal hypertension. Most of these patients had some form of liver disease. We performed various surgical procedures: 47 conventional shunts with H grafts and terminolateral portacaval shunts with arterialization of the portal stump, 139 selective Warren shunts, and in those patients in whom a selective portasystemic shunt could not be performed for technical reasons, esophagogastric devascularization in the form of the Sugiura procedure. Forty-five patients were treated with the Sugiura procedure as a one stage or two stage procedure. A total of 68 emergency and elective operations were performed. The operative mortality rate for the emergency thoracic operation was 41 percent and for the abdominal operation, 42 percent. The overall operative mortality rate in the emergency group was 41 percent. The incidence of recurrent variceal bleeding and encephalopathy was 0 in the surviving patients. The survival rate at 3 year follow-up was 40 percent. The elective group was made up of 24 patients. Eighteen patients had a two stage procedure and 6 patients had a one stage procedure. The operative mortality rate for the abdominal operation was 11 percent, whereas that for the thoracic operation was 7 percent. The operative mortality rate for the one stage procedure was 16 percent. The overall operative mortality rate in the elective group was 10.8 percent. None of these patients had recurrent variceal bleeding and encephalopathy developed in only one (5 percent). The encephalopathy was easily controlled with medical treatment. The 3 year survival rate was 83 percent. We conclude that the Sugiura procedure is an effective procedure to treat hemorrhagic portal hypertension when a selective shunt cannot be performed.     

Bedside modified Clagett procedure for empyema after pulmonary resection

The objective of this study is to demonstrate the effectiveness and feasibility in treating empyema after pulmonary resection with a modified Clagett procedure performed at the bedside (BMCP). A retrospective review of a single surgeon's experience at a single institution was undertaken. All operative, postoperative, and outcome data were analyzed. Follow-up data were obtained from subsequent clinic charts. Five patients, including four males, were identified who underwent BMCP after pulmonary resection. The original operative procedures included two lobectomies, one pneumonectomy, one bilobectomy, and one bilateral metastastectomy. Patients were diagnosed with an empyema (positive thoracostomy tube culture, fever, and radiographic abnormality) at a mean time of 31 days from their initial procedure. Culture results disclosed Gram-positive empyemas in all patients. Three patients underwent BMCP as an outpatient, whereas the other two had BMCP during their hospitalizations. All patients are free from complications or recurrence at a mean follow up of 11.2 months. No patient required a further procedure after BMCP. The bedside modified Clagett procedure is both safe and effective. It is a valuable option in the management of postoperative empyema because it avoids additional operative procedures. This procedure is cost-effective when compared with operative management of perioperative empyema.     

经脐入路腹腔镜腹膜前腹股沟疝修补术4例报告

目的:探讨经脐入路腹腔镜经腹腹膜前腹股沟疝修补术(transabdominal preperitoneal prosthesis,TAPP)的安全性、可行性及近期疗效.方法:用改良腹腔镜器械为4例腹股沟斜疝患者行经脐入路腹腔镜TAPP.观察手术时间、出血量、住院时间及术中、术后并发症.结果:4例手术均获成功,手术时间5...     

Early and late results of subclavian transposition

The subclavian-carotid transposition presents nowadays an elegant procedure for the treatment of the steal syndrome in subclavian stenosis. In 85 patients we were able to establish normal blood pressure without operative mortality. Follow-up examination after a mean time interval of 48 months revealed no reocclusion and 81% had complete relief of symptoms, whereas 18% were improved. The low operative morbidity, combined with the favorable late results demonstrate, that transposition is the method of choice for the treatment of subclavian steal syndrome. The operative procedure and the potential difficulties are described extensively, based on our experiences.     

Selection of Operative Procedures for Cubital Tunnel Syndrome

The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n = 100) followed by academic practice (n = 50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n = 133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient's occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were "very satisfied" with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were "very satisfied" with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference.     

内窥镜在乳房假体包膜挛缩微创治疗中的应用研究

目的依托内窥镜技术，探索微创治疗包膜挛缩的新术式，以求获得满意的手术疗效。方法根据新设计的手术步骤的要求，按切口大小，不同切口的操作需要，以及挛缩部位与乳房的位置关系，在不取出假体的情况下。将内窥镜技术应用于临床包膜松解手术中。手术采用经原隆乳手术切口或乳房下皱襞切口，完成乳房假体的显露后，对于完好的硅凝胶假体或盐水假体，不必取出假体，而在包膜内壁与假体之间，应用内窥镜电刀进行切割及分离包膜，完成包膜的松解。结果应用内窥镜技术，完成包膜松解术4例。术后随访半年，效果良好。结论本术式在保证手术操作易行性的前提下，增加了包膜松解手术切口的选择性及不更换假体完成操作的可行性。微创包膜松解术主要适应于隆乳术后乳房假体包膜挛缩的患者，无论假体内注入的是硅凝胶，还是盐水，均可以采用此方法治疗。