MGLSc并发阴茎头部尿道狭窄手术治疗的临床研究

Clinical evaluation of surgical treatment of glanular urethral strictures caused by MGLSc

目的：探讨尿道外口切开整形术与口腔黏膜尿道成形术在男性生殖器硬化性苔藓样病（MGLSc）并发阴茎头部尿道狭窄的手术治疗效果。方法回顾性分析2008年8月至2012年9月接受手术治疗的MGLSc并发阴茎头部尿道狭窄患者的28例资料。通过病史、体检、尿流率、排泄性膀胱尿道造影进行评估，狭窄限于阴茎头部尿道（长度≤2cm）。患者分为A、B两组，A组12例行口腔黏膜尿道成形术，B组16例行尿道外口切开整形术，术后1、3、6、12、18个月，其后每年规律随访，对比分析两组患者尿流率及尿道外口形态。结果术后随访23.57±10.50个月，A组10例（83.3%）治愈，2例（16.7%）复发，B组6例（37.5%）治愈，10例（62.5%）复发。术后12个月A、B两组的最大尿流率（Qmax）分别为17.71±3.06和14.03±3.85，两组差异具统计学意义（P＜0.05）；A、B两组的成功率分别为83.3%和37.5%，差异具统计学意义（P＜0.05）。结论尿道外口切开整形术后尿道狭窄复发率较高，且阴茎头外形不美观。在MGLSc并发阴茎头部尿道狭窄的治疗中，口腔黏膜尿道成形术优于尿道外口切开整形术，是较理想的治疗方式。

Objective To comparatively analyze the effects of plastic meatotomy and buccal mucosa graft（BMG） urethroplasty in the treatment of glanular urethral strictures caused by Male Genital Lichen Sclerosus（MGLSc）. Methods Clinical data of 28 patients with glanular urethral strictures caused by Male Genital Lichen Sclerosus（MGLSc） who received operation between August 2008 and September 2012 were retrospectively reviewed and evaluated including medical history, physical examination, uroflowmetry and cystourethrography （VCUG）. Stricture was destributed at the glanular urethra （≤2 cm.） of the patients. All patients were divided into two groups, 12 patients in group A were performed with plastic meatotomy and 16 patients in group B with BMG urethroplasty.Voiding symptoms, uroflowmetric parameters and cosmesis were assessed at 1,3,6,12,and 18 months after surgery, and yearly thereafter were comparatively analyzed. Results During a follow-up of 23.57±10.50 months, 10 （83.3%） patients were cured and 2 （16.7%） recurred in group A, while 6 （37.5%） and 10 （62.5%） in group B. Mean Qmax （mL/s） was 17.71±3.06 and 14.03±3.85 respectively in group A and group B at the month of 12 after surgery （P=0.011）. The recovery rate was 83.3% and 37.5% respectively in group A and group B（P=0.023）. Conclusion These results suggest that BMG urethroplasty is superior to plastic meatotomy due to lower recurrence rate and beautiful appearance. BMG urethroplasty may be an ideal approach in the treatment of glanular urethral strictures caused by MGLSc.