男性生殖器硬化性苔藓样变致尿道狭窄合并尿道癌诊治分析  

Urethral carcinoma accompanied by urethral stricture due to male genital lichen sclerosus

作　　者：金重睿[1] 撒应龙[1] 张炯[1] 宋鲁杰[1] 徐月敏[1] 傅强[1] Jin Chongrui;Sa Yinglong;Zhang Jiong;Song Lujie;Xu Yuemin;Fu Qiang(Department of Urology,Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai Eastern Institute For Urological Repair and Reconstruction,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海东方泌尿修复重建研究所,上海200233

出　　处：《中华泌尿外科杂志》2021年第10期763-767,共5页Chinese Journal of Urology

摘　　要：目的探讨男性生殖器硬化性苔藓样变导致尿道狭窄合并尿道癌的临床诊治特点。方法回顾性分析2000年6月至2019年8月上海交通大学附属第六人民医院治疗的16例男性生殖器硬化性苔藓样变导致尿道狭窄合并尿道癌患者的临床资料。患者年龄平均53.7(45~69)岁,生殖器硬化性苔藓样变病程平均15(6~35)年;因前尿道狭窄排尿困难接受尿道扩张或内切开治疗时间平均10(8~15)年。所有病例均表现为阴茎头白斑或硬皮样变,尿道串珠样瘢痕,尿道内出血,有血性分泌物。5例合并阴囊部实质性肿块伴局部疼痛,平均直径4.5(3~7)cm;11例合并会阴部肿块或脓肿,平均直径6.0(4~10)cm,其中9例有尿道皮肤瘘或破溃。阴囊、会阴肿块组织活检病理诊断为浸润性尿路上皮癌12例,鳞状细胞癌4例。盆腔CT、MRI检查示,9例肿瘤侵犯尿道和阴茎海绵体,未见淋巴结肿大;5例肿瘤侵犯尿道和阴茎海绵体,伴一侧腹股沟淋巴结肿大;2例肿瘤累及阴茎海绵体、前列腺包膜外及膀胱颈部,双侧腹股沟淋巴结转移,其中1例累及左侧睾丸。TNM分期:9例T_(2~3)N_(0)M_(0)期,5例T_(2~3)N_(1)M_(0)期,1例T_(3)N_(2)M_(0)期,1例T_(4)N_(2)M_(1)期。5例尿道癌合并阴囊部实质性肿瘤患者中,2例行保留阴茎的阴囊肿瘤和尿道肿瘤切除+尿道近端造口术;3例行阴茎部分切除+远端尿道肿瘤切除+尿道会阴造口术。11例尿道癌合并会阴部感染性肿块患者中,2例行肿瘤组织扩大切除+耻骨上膀胱造瘘术;8例会阴肿瘤感染合并尿道皮肤瘘,其中2例行尿道肿瘤、窦道及周围肿块切除+膀胱造瘘术,4例有一侧腹股沟淋巴结转移,行尿道肿瘤、窦道及周围肿块切除+一侧腹股沟淋巴结切除+膀胱造瘘术,2例合并双侧腹股沟淋巴结转移,行阴茎、尿道全切+双侧腹股沟淋巴结切除+膀胱造瘘术。1例会阴部感染性肿块伴尿道皮肤瘘及一侧淋巴结转移患者(T_(2~3)N_(1)M_(0)期),对�Objective To investigate the characteristics and the management of male genital lichen sclerosus(MGLSc)accompanied by urethral carcinoma.Methods A retrospective analysis was performed on 16MGLSc accompanied by urethral carcinoma patients who were referred to Shanghai Sixth People’s Hospital between June 2000 and August 2019.The average age was 53.7(45-69)years.All of the patients had a mean history of MGLSc 15(6-35)years,anterior urethral stricture received urethral dilatation and other inappropriate urethrotomy treatment for 10(8-15)years.There were 5 cases of solid mass 4.5(3-7)cm in scrotum,accompanied by obviously pain.There were 11 cases of infective masses 6(4-10)cm in the perineum,and the masses were ulcerated with purulent secretions and residue-like pus mixed with necrotic tissues draining from the wounds.Urethrocutaneous fistula developed in 9 cases,and the secretions in the fistula cannot heal.The diseased tissue was confirmed by pathology as the metastasis of invasive urothelial carcinoma in 12 patients and urethral squamous cell carcinoma in 4 patients.9 cases of tumor invaded corpus spongiosum or corpus cavernosum,5 cases invaded corpus spongiosum or corpus cavernosum,with enlarged firm one side inguinal node.2 cases of tumor invaded corpus cavernosum,beyond prostatic capsule and bladder neck,bilateral palpable inguinal lymph nodes metastasis were found,one case found tumor involved the left testis.9 cases were T_(2-3)N_(0)M_(0),5 cases T_(2-3)N_(1)M_(0),1 case T_(3)N_(2)M_(0),1 case T_(4)N_(2)M_(1).5 patients with substantial tumors located in the scrotum,penile-sparing scrotum tumor,urethral tumor resection and urethrostomy was performed in 2 patients.Partial phallectomy,urethral tumor resection and perineal urethrostomy were performed in 3 patients.11 patients with urethral cancer complicated with perineal infectious mass,2 patients underwent extensive resection of the tumor and suprapubic cystostomy.8 cases with perineal tumor infection complicated with urethrocutaneous fistulas formation,of w

关 键 词：尿道肿瘤 硬化性苔藓样变 尿道狭窄 干燥性闭塞性阴茎头炎 治疗 

分 类 号：R737.15[医药卫生—肿瘤] R695[医药卫生—临床医学]