阴囊Paget病诊治分析  

Diagnosis and Therapeutic Methods of Paget's Disease

作　　者：徐杨[1] 陈力博[2] 林英英[3] 岑瑛[1] 

机构地区：[1]四川大学华西医院烧伤整形科,成都610041 [2]四川大学华西医院泌尿外科,成都610041 [3]四川大学华西医院病理科,成都610041

出　　处：《华西医学》2014年第9期1674-1677,共4页West China Medical Journal

摘　　要：目的探讨阴囊Paget病的临床特点及诊治方法。方法纳入2008年一2013年期间经病理证实的18例阴囊Paget病患者，年龄55～81岁，平均69岁。病程9个月～18年，平均6年3个月。最主要的临床表现为瘙痒（94．4％），其他症状体征包括渗液（66．7％）、疼痛（11．1％）、脱屑（5．6％）。所有患者均行病灶扩大切除术。结果随访时间8～52个月，平均34个月。术后病理检查提示4例患者阴茎切缘有病灶累及，其中1例术后出现局部复发，其余14例完全切除的患者均无局部病灶复发。1例病理检查提示合并浸润性腺癌，侵达皮下脂肪组织层，术后20个月出现腹股沟淋巴结转移，1例病理检查提示低分化腺癌伴表皮派杰病形成，并侵及真皮深层，术后18个月肝肺转移。结论阴囊Paget病多见于老年患者，症状以瘙痒为主。多有就诊延迟现象，应及早行病理检查明确诊断。治疗以手术为主，伴有浸润性病变、合并腺癌者预后较差。Objective To investigate the clinical features, diagnosis, therapeutic methods of Paget＇s disease involving the scrotum. Methods The clinical data of 18 patients with Paget＇s disease treated in our hospital between 2008 and 2013 involving the scrotum were analyzed retrospectively. The patients＇ age ranged from 55 to 81 years old with an average of 69. The disease course ranged from 9 months to 18 years, averaging 6 years and 3 months. The main clinical pr was itching （94.4%）, followed by exudation （66.7%）, pain （11.1%）, and desquamation （5.6%）. All patients underwent extended resection. Results The patients were followed up for 8 to 52 months averaging 34 months. Four patients＇ postoperative pathological report found focus on the excision margin, and one of them had local recurrence after 14 months. The remaining 14 cases had no local recurrence. One patient＇s pathological findings reported Paget＇s disease combined with invasive adenocarcinoma which invaded subcutaneous fat tissue layer, and this patient developed inguinal lymph node metastasis 20 months after operation. Another patient combined with adenocarcinoma which invaded deep dermis layer developed liver and lung metastasis 18 months after operation. Conclusions Paget＇s disease involving the scrotum is more commonly seen in older patients, and its main clinical presentation is itching. Paget＇s disease is usually misdiagnosed, so patients should undergo pathological examination early to clear diagnosis. Surgery is the main treatment. Paget＇s disease combined with invasive adenocarcinoma has poor prognosis.

关 键 词：阴囊PAGET病 诊断 治疗 预后 

分 类 号：R737.26[医药卫生—肿瘤]