尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用

目的]探讨尿道切除和膀胱肌瓣尿道成形术在外阴癌治疗中的应用价值。方法]从1970年8月至1998年8月手术治疗外阴癌侵犯尿道者70例。肿瘤侵犯尿道外口或侵犯尿道<1 0cm行2 0cm尿道切除31例 ;肿瘤侵犯尿道下1/2段行全尿道切除39例 ;全尿道切除后用膀胱颈与膀胱不分离膀胱肌瓣尿道重建14例 ,膀胱颈与膀胱分离尿道重建25例。结果]手术并发症 :部分尿道切除者尿失禁4例(12 9 %) ,尿道残端癌复发4例(12 9 %) ;全尿道切除者膀胱阴道瘘4例 ,4例均发生在膀胱颈与膀胱不分离尿道重建法中 ,占28 6 %(4/14)。全尿道切除病例无癌复发。本组总的5年生存率为79%。其中部分尿道切除者为73 1 % ,全尿道切除者为83 3 %。结论]部分尿道切除仅适用于肿瘤侵犯尿道外口或侵犯尿道<1 0cm者 ;全尿道切除适用于肿瘤侵犯尿道下1/2段 ,并能大大减少癌复发和提高生存率。应用膀胱颈与膀胱分离膀胱肌瓣尿道重建 ,还可避免发生膀胱阴道瘘 ,大大提高病人的生活质量

The Value of Urethrectomy and Urethroplasty with BladderMusculature Flap in Treatment of Vulvar Cancer

To study the value of urethrectomy and urethroplasty with bladder musculature flap in treatment of vulvar carcinoma.From Aug.1970 to Aug.1998,seventy patients of vulvar carcinoma with urethra involvement treated surgically.Partial(2.0cm) urethra resection was performed in 31 cases as urethral orifice involvement.Whole urethra resection was performed in 39 cases because of distal half partial was invaded.Urethroplasty with non-separating bladder neck from bladder was done in 14 cases,and with separating bladder neck from bladder in 25 cases.Complication:Four cases (12.9%)occurred urethral recurrence of carcinoma in the patients with partial urethra resection.Four cases occurred vesicovaginal fistula in the patients of whole urethra resection.The four cases all occurred in the cases with bladder neck non-separating from bladder.No recurrence was found in patients with whole urethra resection.The overall 5-year survival rate of seventy patients was 79%.The survival rate of the patients with partial urethra resection was 73.1%,and the rate of patients with whole urethra was 83.3%.Conclusions] Partial urethral resection is only suitable for urethral orifice involved patients.Whole urethral resection is suitable for distal half part of urethra involved patients.It may reduce recurrent rate and increase 5-year survival rate to perform whole urethral resection and urethroplasty with bladder musculature flap.It may improve quality of life especially in patients with urethroplasty with bladder-musculature flap after bladder neck separated from bladder.