乳腺外Paget's病淋巴结清扫适应证的探讨  

Clinical indications for lymph node dissection of extramammary paget's diseases

作　　者：熊玮[1] 王玉荣[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院整形外科,湖北武汉430022

出　　处：《中国医师杂志》2006年第12期1606-1608,共3页Journal of Chinese Physician

摘　　要：目的根据乳腺外Paget's病肿瘤侵犯深度、淋巴结转移及预后情况探讨淋巴结清扫的适应证。方法33例乳腺外Paget's病患者根据肿瘤侵犯深度分为4组:1原位癌(组1),2侵犯真皮乳头层(组2),3侵犯真皮网状层(组3),4侵犯皮下组织(组4)。比较4组患者的年龄、性别比、随访期、是否合并内脏器官恶性肿瘤、淋巴结转移及预后,探讨淋巴结清扫的适应证。结果原位癌及肿瘤侵犯真皮乳头层患者,无淋巴结转移及死亡病例,12例肿瘤侵犯真皮网状层及皮下组织患者中,10例出现淋巴结转移并死亡。5年生存率为:原位癌及肿瘤侵犯真皮乳头层者100%,肿瘤侵犯真皮网状层者33.3%,侵犯皮下组织组无一例生存。结论对于乳腺外Paget's病侵犯真皮网状层及皮下组织患者,在局部扩大切除的同时,需选择性做淋巴结清扫。Objective Analyze our extramammary Paget＇s disease patients in terms of pathological tumor invasion, lymph node metastasis, and prognosis to explore indications for lymph node dissection. Methods 33 patients with extramammary Paget＇s disease were divided into four groups by status of pathological tumor invasion： carcinoma in situ （CIS）, microinvasion to the papillary dermis （MIPD）, invasion to the reticular dermis （IRD）, and invasion to subcutaneous tissues （IST）. Their age, sex ratio, follow-up periods, history of other cancers, lymph node metastasis, and prognosis were compared among the four groups and indications for lymph node dissection were discussed, Results In the groups of CIS and MIPD, all patients appeared to have no lymph node metastasis and death caused by this disease. In the groups of IRD and IST, 10 out of 12 patients showed pathological lymph node metastasis, and all of them died due to metastasis of the tumors, The 5 -year survival rate were 100% in CIS and MIPD groups, 33, 3% in the IRD group, and 0% in the IST group, Conclusion For patients of IRD and IST, lymph node dissection should be selectively performed besides wide local excision.

关 键 词：佩吉特病 乳腺外/治疗 淋巴结切除术 淋巴转移 

分 类 号：R739.5[医药卫生—肿瘤]