阴茎阴囊Paget病局部扩大切除术与根治性切除术的比较研究  

Comparison of wide local excision and radical excision for Paget's disease involving the penis and scrotum

作　　者：孟凡军[1] 蒲怡[1] 陈志兴[1] 岑瑛[1] 陈俊杰[1] 

机构地区：[1]四川大学华西医院美容整形-烧伤外科,成都610041

出　　处：《中国修复重建外科杂志》2017年第6期714-717,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过与根治性切除术比较,评价阴茎阴囊Paget病局部扩大切除术的疗效。方法回顾性分析2010年11月—2015年8月收治并符合选择标准的41例阴茎阴囊Paget病患者临床资料,其中14例采用局部扩大切除术(A组),27例采用根治性切除术(B组)。两组患者年龄、病程、病损部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组复发率、手术时间、术中快速冰冻病理检查次数、术后住院时间、创面愈合分级、患者功能及外观自评满意度评分。结果与B组比较,A组手术时间、术后住院时间均显著缩短,术中快速冰冻病理检查次数减少,比较差异均有统计学意义(P<0.05)。两组患者均获随访,A组随访时间为13~67个月,平均35.5个月;B组11~70个月,平均38.8个月。A组创面甲级愈合11例、乙级愈合2例、丙级愈合1例,B组分别为12、7、8例,两组比较差异有统计学意义(Z=–2.102,P=0.036)。术后5年内A组复发4例(28.6%),B组复发6例(22.2%),比较差异无统计学意义(χ2=0.202,P=0.654)。末次随访时,A组患者外观及功能自评满意度评分显著高于B组,比较差异有统计学意义(t=–2.810,P=0.008)。结论阴茎阴囊Paget病进展缓慢,预后良好,局部扩大切除术可有效去除症状,降低老年患者围手术期风险,且术后复发率较根治性切除术未明显升高。Objective To evaluate the effectiveness and advantages of the wide local excision for Paget＇s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget＇s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision （group A）, and 27 patients received radical excision （group B）. No significant difference was found in age, course of disease, and lesion site between two groups （P〉0.05）. The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B （P〈0.05）; the times of intraoperative frozen section pathology in group A were significantly less than that in group B （P〈0.05）. All patients were followed up 13 to 67 months （mean, 35.5 months） in group A and 11 to 70 months （mean, 38.8 months） in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups （Z=-2.102, P=0.036）. The 5-year recurrence rate was 28.6% （4/14） in group A and 22.2% （6/27） in group B, showing no significant difference （X2=0.202, P=0.654）. The score of satisfaction in appearance and functions in group A was significantly higher than that in group B （t=-2.810, P=0.008）. Condusion Paget＇s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.

关 键 词：阴茎阴囊Paget病 局部扩大切除术 根治性切除术 复发率 

分 类 号：R699.8[医药卫生—泌尿科学]