老年男性尿道尖锐湿疣的诊断与治疗

目的　探讨老年男性尿道尖锐湿疣 (Condyloma accuminatum,CA)诊断、治疗和预防复发的方法。方法　临床、尿道镜及病理学诊断的 1 7例老年尿道 CA病人分成尿道切开组和 5-氟尿嘧啶 (5- FU)组。 5- FU组采用自制尿道撑开器及经尿道汽化电切方法切除疣体后同时用 5% 5-FU液局部浸泡和尿道灌注预防复发和治疗亚临床感染。结果　随访 3～ 1 6个月 ,5- FU组有 1 2例 1次治愈 (92 .3% ) ,1例 (7.6% )复发 ;而尿道切开组 6例中有 4例 1次治愈 (66.7% ) ,2例 (33.3% )复发 ,差异明显。 5- FU浸泡阴茎及灌注尿道未见副作用。尿道切开组有 2例出现切口愈合不良。结论　尿道镜检查是诊断治疗尿道 CA的最重要手段 ,尽量避免采取尿道切开方法治疗尿道 CA,5% 5- FU局部浸泡和尿道灌注可治疗人乳头瘤病毒(HPV)的亚临床感染 ,预防复发。

Diagnosis and treatment of urethral condyloma accuminatum in senile male patients

Objective To discuss diagnosis and treatment and prevention of recurrence of urethral condyloma accuminatum (CA) in senile male patients. Methods 17 senile patients, who were diagnosed by clinical manifestations and urethroscopy and pathology, were divided into the urethrotomy group and 5-FU group. The therapy for 5-FU group consisted of urethrotomy and electrofulguration, intraurethral instillation and local therapy of 5% 5-fluorouracil solution, which were used to prevent recurrence and treat sub-clinical infection. Results All patients were followed up from 3 to 16 months. 12 cases (92.3%) were cured primarily and 1 case (7.6%) relapsed into CA in 5-FU group. Whereas, 4 cases (66.7%) were cured and 2 cases (33.3%) relapsed into CA in urethrotomy group. Significant difference exists between the two groups. No side effect of intraurethral instillation and local therapy could be seen. Conclusions Treatment and prevention of CA in senile male patients should be paid attention by society. Urethroscopy is an important method to diagnose and treat urethral CA, and urethrotomy should be avoided as possible in the treatment of urethral CA. Intraurethral instillation and local therapy of 5% 5-fluorouracil solution can prevent subclinical infection of human papillomavirus.