改良Mohs显微描记手术在原发性乳房外Paget病中的应用  

Clinical research in multiple modified Mohs microsurgery to treat Extramammary Paget's disease

作　　者：谢凯 郭璇[1] 耿建辉[1] 王学庆 王金良[1] 刘国艳 XIE Kai;GUO Xuan;GENG Jianhui;WANG Xueqing;WANG Jinliang;LIU Guoyan(Shandong Provincial Hospital for Skin Disease&Shandong Provincial Institute of Dermatology and Venereology,Shandong First Medial University&Shandong Academy of Medical Sciences,Jinan 250001,China)

机构地区：[1]山东第一医科大学附属皮肤病医院(山东省皮肤病医院),山东省皮肤病性病防治研究所,山东济南250022

出　　处：《中国麻风皮肤病杂志》2023年第11期808-812,共5页China Journal of Leprosy and Skin Diseases

摘　　要：目的:研究探讨改良莫氏显微描记手术(modified Mohs microsurgery,mMMS)在原发性乳房外Paget病(extramammary Paget s disease,EMPD)中的应用。方法:对2021年8月至2022年12月我院收治的8例原发性乳房外Paget病手术病例进行回顾性分析。结果:8例患者术前均行光动力判断肿瘤边缘,其中2例患者行传统扩大切除治疗(wide local excision,WLE),3例患者行周围组织的快Mohs手术(rapid peripheral MMS,rpMMS),3例患者行周围组织的慢Mohs手术(slow peripheral MMS,spMMS)。1例WLE治疗患者冰冻切片术后常规组织病理复核出现假阴性切缘,予以局部放射治疗,其余WLE、rpMMS治疗患者未出现假阴性切缘。结论:周围组织的MMS(pMMS)治疗原发性EMDP,可在保证肿瘤切净率的同时提高手术效率,spMMS可有效规避EMPD冰冻切片的不准确性及大面积创面暴露的感染、出血风险。Objective:To explore the clinically efficacy of multiple modified Mohs microsurgery(mMMS)in treating extramammary Paget's disease(EMPD).Methods:A retrospective review was carried out to analyze the clinical data of 8 cases of primary EMPD(pEMPD)treated by MMS during Aug.2021 to Dec.2022 in our hospital.Results:All eight patients underwent preoperative photodynamic therapy to judge the tumor margins.Among these patients,two patients underwent traditional wide local excision(WLE)therapy,three patients underwent the rapid peripheral MMS(rpMMS),and the other three patients underwent the slow peripheral MMS(spMMS).One patient treated with WLE had a false negative margin,and was treated with radiotherapy.No false negative margin was found in the other patients treated with WLE or rpMMS.Conclusions:Adopting the peripheral MMS(pMMS)to treat pEMDP can ensure the complete resection rate and improve surgical efficiency at the same time.spMMS can effectively avoid the inaccuracy of EMPD frozen sections and the risks of infection and bleeding caused by large-area wound exposure.

关 键 词：乳房外PAGET病 Mohs显微描记手术 

分 类 号：R739.5[医药卫生—肿瘤]