阴茎阴囊Paget氏病9例报告  

Extramammary Paget's disease of the penis and scrotum:reports of 9 cases

作　　者：武宝通[1] 王友宝[1] 夏清建[1] 曲江磊[1] 祝昌明[1] 陈长宜[1] 

机构地区：[1]青岛大学医学院附属青岛市海慈医院泌尿外科,256603

出　　处：《现代泌尿生殖肿瘤杂志》2011年第5期275-276,279,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的提高对阴茎阴囊Paget氏病的认识,做到早期诊断,减少误诊率,提高治疗效果。方法本组阴茎阴囊Paget氏病患者共9例,年龄55～83岁,平均69岁。病程6个月～11年。主要临床表现为阴茎阴囊皮肤瘙痒、红斑、糜烂、渗液,可见局部皮肤表面粗糙、皮损逐渐扩大,稍隆起。Ray分期标准,A1期5例,A2期3例,B期1例。9例均行手术治疗,距病灶边缘2.0cm切除病变区域,深度达深筋膜,术中快速冷冻切片检查,肿瘤细胞累及切缘者1例,即予以扩大切除范围。1例术后病理发现肿瘤累及切缘,随即再次手术治疗。结果 9例均经病理学检查确诊。切口Ⅰ期愈合7例,Ⅱ期愈合1例,切口感染1例,经换药后治愈。术后6例获随访,随访时间1～10年。1例术后1年出现局部复发,复发灶位于原手术切口,再次手术治疗后痊愈。死亡2例,死亡原因均与本病无关。结论对阴茎阴囊皮损的可疑Paget氏病患者应尽早行组织学活检,确诊后行病灶根治性切除术。本病预后良好。Objective To improve the understanding,diagnosis and treatment of Paget＇s disease of scrotum.Methods 9 cases （mean age,69 years;age range,55-83 years） of penile and scrotal Paget＇s disease were included.The disease duration was 6 months to 11 years.The main clinical presentations consisted of itching,erythema,erosion,exudation of scrotal skin.Grossly,the local diseased skin had rough surface,extended lesion and was slightly prominent,sometimes cauliflower-like.According to Ray staging,5,3 and 1 cases had A1,A2 and B stages of Paget＇s disease,respectively.All the cases underwent surgical resection of the diseased sites.The incision margin was 2.0 cm apart from the edge of the lesion,and resection depth reached deep fascia.During operation,frozen sections of the excised tissues samples were pathologically examined,the excision margins were involved by tumor cells in 1 cases,therefore extended excision was performed immediately.Postoperatively,excision margin involvement was confirmed in 1 cases and phase Ⅱ operation was performed.Results Paget＇s disease was confirmed in all 9 cases.Of them,7 cases had phase Ⅰ wound healing,1 had phase Ⅱ healing,1 had incision infection and were cured by wound dressing.6 cases followed for 1 to 10 years.Of these cases,1 had tumor recurrence 1 year after operation,and recurrences in the original incision.This case was cured after second operation.Conclusions Chronic skin lesions of the penis and scrotum should be biopsied as early as possible if they are suspected of Paget＇s disease.Radical resection of the diseased skin is the key point.The prognosis of extramammary Paget＇s disease after radical surgery is good.

关 键 词：氏病 阴囊 阴茎 

分 类 号：R739.5[医药卫生—肿瘤]