CAJ | 학술논문

目的提高对硬化性苔藓样病( lichen 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-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 ～20.0 cm,平均11.5 cm.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17.2～47.0 ml/s,平均23.4 ml/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.
목적 제고대경화성태선양병( lichen sclerosus,LS)도치뇨도협착적인식,관찰유리점막뇨도성형치료LS소치뇨도협착적료효. 방법 2007년1월-2010년12월수치LS소치전뇨도협착환자36례,년령27～75세,평균41세.뇨도협착단장5.0 ～20.0 cm,평균11.5 cm.근거뇨도협착단장단화엄중정도선택불동적점막조직,기중행구강내점막(설、협점막)뇨도성형27례,결장점막뇨도성형8례,령1례노년환자행전뇨도벽개.재행뇨도중건술전대병변루급적음경두、뇨도구、뇨도행병이학검사. 결과 36례환자술후3주발제도뇨관,배뇨통창;활검결과제시상피기저부특정성병변,과도각화,상피층변박,림파세포침윤등.술후수방6 ～ 50개월,평균22개월.출현뇨도외구협착3례(8.3％),기중구강내점막뇨도성형자2례,결장점막중건뇨도자1례,행뇨도외구절개후배뇨통창.여환자술후배뇨통창,최대뇨류솔17.2～47.0 ml/s,평균23.4 ml/s. 결론 채용유리점막뇨도성형치료LS소치뇨도협착료효교호,단수밀절수방,인병변천연가치뇨도재협착,우기시뇨도구재협착.
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 buccal 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 perivascular 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 mucosas 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.