摘要
目的：探讨重症硬化性苔藓样变（lichensclerosus，LS）相关的次全尿道狭窄的治疗术式的选择与效果以及病变尿道标本的组织学评价。方法回顾性分析2003年1月至2014年12月采用不同黏膜一期尿道成形术治疗的78例重症LS相关的次全尿道狭窄患者资料。患者年龄38～72岁，平均48岁。尿道狭窄长度11．0～22．0cm，平均（14．3±2．6）cm。会阴部正中切口或阴茎冠状沟环状切口加会阴部切口，随后采用2种术式：①将狭窄段尿道左侧从阴茎海绵体分离出，并于背侧纵向切开狭窄段并超过正常尿道腔1．5cm左右。取宽1．5～2．0cm、长按需要的口腔内黏膜移植到狭窄段尿道行扩大尿道成形术（50例）。②对尿道严重狭窄或闭锁的患者，切除严重狭窄的尿道后采用结肠黏膜（宽3．0cm，长按需要）重建尿道（28例）。术中在阴茎头和尿道做多处活检，标本送病理检查。结果本组78例术后随访6～110个月，平均48．3个月。69例（88．5％）排尿通畅，最大尿流率15．2～47．0ml／s，平均23．4ml／s，尿道造影示替代段尿道管径粗大。9例（11．5％）发生与尿道相关的并发症，其中3例因感染致尿道皮肤瘘，需再次手术修补；6例于术后3～11个月发生尿道外口狭窄，经外口成形后排尿通畅。病理学检查显示LS的阳性率分别为阴茎头部100．0％，尿道口88．5％。球部尿道活检主要表现为鳞状细胞化生，未发现典型的LS组织学表现；然而，在2例活检组织中见胶原均质化伴弥漫性淋巴细胞浸润，另2例尿道上皮显示过度角化，极类似皮肤。结论采用口腔内黏膜尿道成形是治疗LS相关次全尿道狭窄的有效方法，结肠黏膜一期重建尿道适合治疗特别严重的、闭锁性尿道狭窄。在球部尿道标本中未发现典型的LS组织学依据。
Objective To explore the procedure selection and outcomes of treatment for the patients with severe panurethral strictures secondary to lichen sclerosus （ LS ） and evaluated the bulbar urethral specimens histologically . Methods Seventy-eight patients with severe panurethral strictures of LS underwent one-stage urethroplasty using different mucosal grafts between January 2003 and December 2014. The mean age was 48 years （range 38-72）.The mean stricture length was 14.3 ±2.6 cm （range 11.0-22.0）.Midline perineal incisions or circumcoronal and midline perineal incisions were used and two procedures were chosen as follow：①the strictured urethras were dissected from the corpora cavernosa only along the left side and the stricture urethras were opened by a dorsal longitudinal incision which extended about 1.5 cm into the proximal healthy urethras .The strictured urethras were augmented using oral mucosal grafts（1.5 to 2.0 cm in width and an appropriate in length ） （ n=50）; ② for the patients whose urethras were very narrow or obliterated , the urethras were reconstructed using colonic mucosal graft （ 3 cm in width and an appropriate in length）after the severe strictured urethras were excised （n=28）.Biopsies were taken separately from the urethral meatus and bulbar urethral specimens .Results All of the 78 patients were followed up for 6-110 months （mean of 48.3 months）.Sixty-nine patients （88.5%） urinated well, with the mean urinary peak flow rate of 23.4 ml/s （ range 15.2-47.0 ml/s ） , and urethrography showed that each had a patent urethra with adequate lumen .Complications associated with urethra occurred in 9 patients （11.5%） . Three patients developed urinary fistula secondary to infection , which required surgical correction;6 patients developed meatal stenosis 3 -11 months postoperatively , and all voided well after meatoplasty.The incidence of LS-positive biopsies was 100.0%in the glans and 88.5%in the meatus.In the bulbar urethral mucosa , the histological alteration in all biopsies was squamous metaplasia of the hyperplasia , and no histological evidence of typical LS was documented .However , homogenization of the collagen with diffuse lymphocyte infiltration was observed in the bulbar urethral specimens of 2 patients, and squamous metaplasia of the hyperplasia with serious orthokeratosis that was similar to its cutaneous counterpart was found in another 2 patients.Conclusions Our study suggests that urethroplasty with oral mucosal grafts is effective to treat panurethral stricture associated with LS .Urethroplasty with a colonic mucosal graft is suitable for repairing very severe strictured or obliterated urethra .No histological evidence of typical LS is observed in the bulbar urethral specimens .
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第10期786-789,共4页
Chinese Journal of Urology
关键词
尿道狭窄
硬化性苔藓样变
结肠黏膜
尿道重建
Urethral stricture
Lichen sclerosus
Colonic mucosa
Urethral reconstruction
