硬化性萎缩性苔藓样变尿道狭窄23例病理特征分析

Pathological features of 23 cases of lichen sclerosis urethral stricture

目的分析因硬化性萎缩性苔藓样变(LS)导致尿道狭窄患者的临床信息与组织学特征,研究LS患者病理学分期与尿道狭窄病变程度之间的关系。方法回顾性分析2017-2020年因LS导致尿道狭窄于我院泌尿外科就诊并行手术治疗的23例男性患者的临床资料。纳入患者病史资料均完整,且在术中取得病变尿道外口组织并经组织病理学确诊为LS。分析了患者病理学分期与狭窄累及部位、尿道造影毛刺样改变以及尿道狭窄病程间的关系。结果纳入23例患者,平均年龄(52.6±15.8)岁,平均尿道狭窄病程(12.2±9.0)年。除1例患者外,所有患者均存在龟头白变或白斑。13例(56.5%)纳入患者的尿道造影存在毛刺样改变。符合LS诊断标准3项者5例、4项者10例、5项者8例;所有患者均有表皮角化过度或角化不全的表现,而基底细胞层退变最为少见。符合LS病理改变者早期9例、中期10例、晚期4例。患者病理学分期与狭窄累及部位和尿道造影有无毛刺样改变无显著相关(P=0.758/0.307)。不同病理学分期患者间尿道狭窄病程差异无统计学意义(P=0.788)。结论LS尿道狭窄患者病程长短不一,狭窄累及部位多样,且组织病理学特征常不典型,分期较难。LS尿道狭窄累及部位、尿道造影有无毛刺样改变及尿道狭窄病程与病理学分期间无显著相关,可能受到其他多种因素影响。患者临床表现与病理改变之间的关系有待进一步研究。

Objective To analyze the clinical and histological characteristics of patients with urethral stricture caused by lichen sclerosis(LS),and to explore the relationship between pathological stages of LS and degree of urethral stricture.Methods The clinical data of 23 male patients with LS urethral stricture treated during 2017 and 2020 were retrospectively analyzed.The medical history of all patients was complete,and all cases were confirmed.The correlation among histopatholo-gical stage,stricture site,burr-like changes in urethrogram and course of urethral stricture was analyzed.Results The average age of patients was(52.6±15.8)years,and the average duration of urethral stricture was(12.2±9.0)years.All but 1 patient had leukoplakia or leukoplakia on the glans.Burr-like changes were observed on urethrogram in 56.5%of the patients.There were 5 patients meeting 3 diagnostic criteria of LS,10 meeting 4 criteria,and 8 meeting 5 criteria.All patients had manifestations of hyperkeratosis or hypokeratosis,and basal cell layer degeneration was rare.There were 9 patients with early patholo-gical changes,10 with intermediate and 4 with advanced pathological changes.There was no significant correlation between the pathological stage and stricture site and presence of burr-like changes(P=0.758/0.037).There was no significant difference in the course of urethral stricture among patients in different pathological stages(P=0.788).Conclusion Patients with LS urethral stricture vary in courses and urethral sites.The histopathological characteristics are often atypical,and the histopatholo-gical staging is difficult.The segment involved in LS urethral stricture has no significant correlation with pathological stages and might be affected by many other factors.More study is needed to clarify the relationship between clinical manifestations and histopathological changes.