阴囊Paget's病

Paget's disease of scrotum

目的进一步提高对阴囊Paget s病的认识,做到早期诊断,减少误诊率,提高治疗效果。方法结合国内外文献,从对本病的生物学行为、分期、发病机理及诊断和治疗等方面对本组3例阴囊Paget s病进行全面的分析研究,并提出了新的见解。结果例1系复发性阴囊Paget s病,经再次手术切除加术后放疗,至今已随访半年余,无瘤健存;例2属ⅣA期,行病变广泛切除、双腹股沟淋巴结清扫、皮片植移术,术后辅以综合治疗,虽荷瘤生存,但尚能完成部分日常工作,疗效尚属满意,但终因肿瘤广泛转移于出院7个月左右死亡;例3未手术治疗,病变略有增大。另外我们对本病提出了新的分期方法,对本病的生物学行为及Ⅳ期患者和复发患者的治疗亦提出了我们新的见解,并取得一定效果。结论对Ⅳ期患者采用手术加术后综合治疗能改善生活质量,延长生存期。复发患者仍以手术加术后局部放疗为宜,可获满意疗效。此外,我们提出的新分期法能准确评估病情,对临床制定适宜的治疗方案有很强的指导价值。

Objective To improve the understanding, diagnosis and treatment of Paget＇s disease of scrotum and reduce thc misdiagnosis. Methods The data of 3 patients with Pagct＇s disease of scrotum were analyzed retrospectively with litcraturc in the biological behaviour, staging, pathogenesis, diagnosis and treatment of the disease. Results One patient with recurrence underwent local excision of the lesion and then radiotherapy. So far, no tumor recurred during the 6 months followup. Extensive excision of the lesion, bilateral inguinal lymphadenectomy and skin flap grafting were performed on the other patient in stage Ⅳ and followed by combining therapy. The patient died from extensive matastasis 7 months postoperation, although he remained productive. The third patient received no treatment and his condition was worsened. In addition, we designed a new staging system for the disease. CONClUSiON The local excision of the lesion and combining therapy in patients in stage Ⅳ can improve the quality of life and survial rate. Surgery and radiotherapy postoperation are optimal for the patients with recurrence. The new staging system for the disease can be used to evaluate accurately the condition of the patients and it is practical and instructive to establish an appropriate treatment.