摘要
目的提高对硬化性苔藓样病（1ichen sclerosus，LS）导致尿道狭窄的认识，观察游离黏膜尿道成形治疗Ls所致尿道狭窄的疗效。方法2007年1月一2010年12月收治Ls所致前尿道狭窄患者36例，年龄27～75岁，平均41岁。尿道狭窄段长5．0—20．0cm，平均11．5cm。根据尿道狭窄段长短和严重程度选择不同的黏膜组织，其中行口腔内黏膜（舌、颊黏膜）尿道成形27例，结肠黏膜尿道成形8例，另1例老年患者行前尿道劈开。在行尿道重建术前对病变累及的阴茎头、尿道口、尿道行病理学检查。结果36例患者术后3周拔除导尿管，排尿通畅；活检结果提示上皮基底部特征性病变，过度角化，上皮层变薄，淋巴细胞浸润等。术后随访6～50个月，平均22个月。出现尿道外口狭窄3例（8．3％），其中口腔内黏膜尿道成形者2例，结肠黏膜重建尿道者1例，行尿道外口切开后排尿通畅。余患者术后排尿通畅，最大尿流率17．2～47．0ml／s，平均23．4ml／s。结论采用游离黏膜尿道成形治疗LS所致尿道狭窄疗效较好，但需密切随访，因病变迁延可致尿道再狭窄，尤其是尿道口再狭窄。
Objective To improve the recognition of lichen sclerosus （LS） involving the anterior urethral strictures and to investigate the outcome of urethroplasty using free mucosal grafts for the treatment of urethral strictures caused by LS. Methods From January 2007 to December 2010, 36 patients with anterior urethral strictures caused by LS were treated using oral mucosal grafts or colonic urethroplasty. The mean age was 41 years （range, 27 -75） and the mean anterior urethral stricture length was 11.5 cm （range, 5.0 -20.0 cm）. Of the 36 patients, 27 patients underwent dorsal lingual mucosal graft or combined buceal mucosal graft urethrography. Eight patients underwent colonic mucosal urethrography according to the length and seriousness of urethral strictures, and the remaining patient underwent anterior urethral split. Biopsies were taken from the glans, urethral meatus and urethra before urethroplasty. Results The urethral silicone stent was removed 21 d post-operatively and all the patients voided well. An epithelial-stromal lesion characterized by hyperkeratosis, thinned epithelium and diffuse perivaseular lymphocyte infiltrate was seen upon histological examination of the biopsied areas. The mean follow-up was 22 （ range, 6 - 50） months post-operatively. Meatal stenosis developed in 2 patients undergoing oral mueosas urethroplasty and 1 patient with colonic urethroplasty, the patients voided very well after re-operation. The other patients voided well and the urinary peak flow rates ranged from 17.2 to 47.0 ml/s （ mean, 23.4）. Conclusions Free mucosal grafts urethroplasty can obtain good results for the treatment of urethral strictures caused by LS. But there is a risk of recurrence of urethral stricture and closing follow-up is required, especially for meatal stenosis.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2011年第11期732-735,共4页
Chinese Journal of Urology
关键词
硬化萎缩苔藓
干燥性闭塞性阴茎头炎
尿道狭窄
游离黏膜
尿道成形
Lichen sclerosus et atrophicus
Balanitis xerotica obliterans
Urethral stricture
Free mucosa
Urethroplasty
