改良尿道会师术治疗后尿道断裂56例

A Modified Technique of Urethral Reunion Operation in 56 Cases

目的 对后尿道断裂复位固定术进行改良，探讨其治疗效果。方法 经膀胱尿道会师术后留置双腔气囊导尿管，从膀胱颈４ 点和８ 点处采用１０－０ 丝线缝合会阴部，使后尿道两端复位固定。结果 该疗法共治疗后尿道断裂５６ 例，总治愈率为８５ ．７％ （４８／５６） ，无阳萎和尿失禁，８例（１４．３ ％） 需尿道扩张。结论 改良尿道会师术克服了传统术式存在的诸多不足，具有操作简单、手术时间短、疗效好。

Objective To explore the therapeutic effect of a newly modified technique of urethral reunion operation for posterior urethra rupture.Methods The new technique was used in 56 patients with posterier urethrol rupture. A Long straight needle with No.10 silk suture was penetratad through the bladder neck at 4 point and 8 point seperately to the perineum aftar urethral realignment.The ends of the two sutures were tied over a rubber bolster at the perineum.The upward displaced prostate was thus reduced and the disrupted urethral ends were abutted against each other. Results The follow_up of the 56 patiants showed excellent results. The total cure rate was 58.7%.No impotence and urinary incontinence was found. Conclusions The newly modified technique has the advantages of simple operation, short time of surgery,good effect, and less complications. Key words Wounds and injuries Urethra, posterior Modified urethral reunion operationinoperable chest wall recurrence(>100?cm 2),underwent two methods of radiotherapy for salvage.7 cases were treated by highdose rate plesiocurietherapy.with CT scan and TPS optimization process,6～8?Gy(4～5 mm under the skin surface) 2 or 3 courses within 10～15 d;10 cases were treated by conventional external irradiation,30～50?Gy with 10 MeV electron beam and 1?cm compensation material,(6 cases);or plus two tangential fields with total dose of 44～60?Gy/30～40?d(4?cases).RESULTS 6/7cases (86%) achieved complete clinical regression locally one month after the plesiocurietherapy without evident respirational complication.And in the conventional radiotherapy group,6/10 cases(60%) presented a local control 3～5 monthes after the treatment,but 2 had radiation pneumonitis.CONCLUSIONS The high dose rate plesiocurietherapy,plus CT scan and TPS optimization process,is a feasible,effective salvage method for extensive locally recurrent breast cancer following chest wall postoperative irradiation,with high local control probability and low complication rate.