中国31例肛周Paget病的临床特点

The clinical characteristics of 31 cases of PPD in China

目的总结肛周Paget病的临床特点。方法回顾性分析国内发表的30例肛周Paget病和1例本院的临床资料。结果发病男女之比为2.4∶1,平均年龄65岁;症状有肛周瘙痒(67.7%),湿疹样改变(54.8%),肛周赘生物(38.7%),糜烂、溃疡(36.1%),肛周分泌物(35.5%),大便习惯改变(22.6%),腹股沟肿块(12.9%),灰白苔样物(12.9%)和红肿(6.5%)等。误诊率高达67.7%,经常被误诊疾病为湿疹(48.4%)、痔(12.9%)和慢性炎症(6.4%)。总手术率为90.3%,局部广泛切除占35.5%,Miles术占54.8%。结论肛周Paget病在中国以老年男性居多,PPD的诊断依赖于典型的临床症状和病理检查;手术切除是最有效的治疗手段;对于远处转移者可辅以放疗和化疗等手段。

Objective To summarize the clinical characteristics of per/anal Paget＇s disease （PPD）. Methods The clinical data of 31 PPD cases in China （including one case in our hospital） were collected and analyzed retrospectively. Results The ratio of men to women was 2.4 ： 1, mean age was 65 years old. Symptoms included perianal itch （67.7%）, eczema （54.8%）, perianal ecphyma （41.9%）, anabrosis or anabrosis （36. 1%）, perianal secretion （35.5%）, change in habits of defecation （22.6%）, lump in the groin （12.9%）, white fur （11%） and flare （6.5%）. Misdiagnosis rate reached up to 67.7%. Eczema （48.4%）, haemorrhoids （12.9%） and chronic inflammation （6.4%） were used to calculate misdiagnosis. 90. 3% of the patients were operated on, among which 35.5% of cases underwent wide local excision and 54.8% patients received abdominoperineal resection. Conclusion PPD is more common in elderly male patients. Surgery is the most effective modality for treatment ; radiotherapy and chemotherapy can be selected for patients with distal metastasis.