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[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
[Objective] To investigate the value of urethral resection and bladder muscle flap urethroplasty in the treatment of vulvar cancer. [Method] From August 1970 to August 1998, 70 cases of genitourinary carcinoma invading the urethra were surgically treated. Tumor invading the urethral orifice or violated the urethra <110cm line 20cm urethral resection in 31 cases; invasion of the urethra 1/2 underwent total urethral resection in 39 cases; after urethral resection of the bladder neck and bladder with bladder muscle flap urethral reconstruction in 14 cases , Bladder neck and bladder separation urethra reconstruction in 25 cases. [Results] Surgical complications included 4 cases (12.9%) of urinary incontinence and 4 (12.9%) cases of urinary incontinence in partial urethral resection; 4 cases of vesicovaginal fistula in total urethral resection and 4 cases of bladder urinary incontinence Neck and bladder separation urethral reconstruction method, accounting for 28 6% (4/14). Total urethral resection without cancer recurrence. The overall 5-year survival rate was 79%. Among them, partial urethral resection was 73 1% and total urethral resection was 83 3%. [Conclusion] Partial urethral resection is only suitable for tumors invading the external urethral orifice or violating the urethra <10cm. Total urethral resection is suitable for cancers to invade the lower urethra 1/2 and can greatly reduce the recurrence of cancer and increase the survival rate. Application of bladder neck and bladder bladder muscle flap urethral reconstruction, but also to avoid the occurrence of vesicoureteral fistula, greatly improving the quality of life of patients