男性生殖器和会阴部paget病40例的手术方式选择  

Selection of surgical methods for 40 cases of Paget’s disease of male genitalia and perineum

作　　者：杨龙雨禾 邱学德[1] 王跃强 张贵福 YANG Longyuhe;QIU Xuede;WANG yueqiang;ZHANG Guifu(Department of Andrology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650032,China;Department of Urology, The First People’s Hospital of Honghe, Mengzi 661000, Yunnan, China)

机构地区：[1]昆明医科大学第二附属医院男性科,云南昆明650032 [2]红河州第一人民医院泌尿外科,云南蒙自661000

出　　处：《西部医学》2021年第2期280-283,共4页Medical Journal of West China

摘　　要：目的总结乳腺外Paget病的特点和外科治疗方法,提高手术水平,降低复发率。方法回顾性分析昆明医科大学第二附属医院男性科收治的40例生殖器会阴部Paget病患者临床资料。其中6位患者创面行一期缝合;34位患者因皮肤缺损面积较大,10例采用阴囊皮瓣覆盖;20例采用中厚皮移植;4例应用游离股内侧皮瓣修复创面。结果40例患者均切除所有病损组织,创面手术愈合良好。除2例复发行二次手术外,其余随访一年未见皮肤坏死及淋巴结转移。结论EMPD是一种罕见的恶性肿瘤,由于它不对称扩散,难以获得完整的阴性切缘,以往治疗结果欠佳,采用标记皮肤区域和广泛切除的方法使获得阴性切缘更为高效和可靠。根据创面大小使用不同方式进行修补,能取得很好的恢复效果。Objective To summarize the characteristics and surgical treatment of extramammary Paget disease(EMPD),improve the diagnosis and treatment,and reduce the recurrence rate.Methods The clinical data of 40 patients with Paget’s disease in perineum were analyzed,retrospectively.Six patients were sutured in one stage,34 patients were covered with scrotal flap,20 patients were transplanted with medium thickness skin,and 4 patients were repaired with free medial femoral flap.Results All the 40 patients were excised and the wound healed well.No skin necrosis and lymph node metastasis were found except 2 cases of reoperation.Conclusion EMPD is a rare malignant tumor,and the previous treatment is not good.Because of its asymmetric diffusion,it is difficult to obtain a complete negative margin.It is more efficient and reliable to obtain a negative margin by marking the skin area and extensive resection.According to the size of the wound,different methods of repair can achieve a good recovery effect.

关 键 词：湿疹样癌 皮瓣移植 乳外Paget病 大面积病损切除 

分 类 号：R739.5[医药卫生—肿瘤]