会阴部Paget's病的外科治疗

SURGICAL TREATMENT OF PERINEAL PAGET'S DISEASE

目的总结会阴部Paget's病外科手术治疗方法及疗效。方法1998年1月～2004年9月,对20例会阴部Paget's病患者行手术治疗,均为男性,年龄47～80岁。病程1～9年,平均4.7年。单纯累及阴囊14例,阴囊及阴茎同时受累5例,阴囊、阴茎及下腹部受累1例。15例术前病理检查确诊为Paget's病,均未发现转移。结果19例患者术后伤口期愈合;1例植皮区部分坏死,经换药后期愈合。20例均获随访2～5年,阴囊及阴茎外形满意。2例分别于术后6个月及1年复发,再次手术切除后好转。2例于术后6个月因阴茎腹侧瘢痕挛缩致勃起时出现下弯畸形,经局麻下皮瓣移位调整后好转;余患者术后阴茎勃起功能正常。结论会阴部经久不愈的湿疹样病损应高度怀疑Paget's病,尽早行病理活检可明确诊断;广泛彻底切除是唯一有效的治疗方法;肿瘤切除后创面应尽量采用阴囊皮瓣修复,也可联合阴茎及下腹皮瓣移位或结合游离植皮修复创面;同时术后应密切随访。

Objective To investigate the surgical methods and effects of perineal Paget＇s disease. Methods From January 1998 to September 2004, 20 perineal Paget＇s disease cases were treated with several surgical methods. All the patients were male. Their ages ranged from 47 to 80 years. The courses of diseases ranged from 1 year to 9 years （4.7 years on average）. Among them, 14 cases involved scrotums purely, 5 cases involved scrotums and penises, 1 cases involved scrotum, penis and hypogastric zone. Fifteen cases were diagnosed as having Paget＇s disease through pathological exam. No metastasis was found before operation. Results The wounds healed by first intention in 19 cases, the free skin graft necrosed partially in 1 case and healed by second intention after dress-changing. All the patients were followed up 2 to 5 years, the contours of scrotums and penises were good. Two cases had tumor recurrence and received surgery again. Recurvation occurred in 2 cases during penis erecting,and was corrected by regional flap transplantation. Conclusion The lesions like eczema in perineal reigon should be suspected as Paget＇s disease, and should be biopsied earlier. Complete removal by surgery is the only effective treatment. Perineal Padget＇s disease should be diagnosed and treated earlier. If the raw surfaces could not be repaired completely, flap transplantation and free skin graft should be used . The patients should be followed up closely.