46例阴茎癌的临床分析及总结——附文献复习

Diagnosis and Therapy for Penile Cancer:A Report of 46 Cases with Literature Review

背景与目的:阴茎癌是一种少见的疾病,以鳞状细胞癌为主,主要通过淋巴途径转移。治疗包括局部原发癌切除和对转移淋巴结的处理及放疗、化疗等辅助治疗。本研究旨在探讨阴茎癌合理的治疗方法。方法:对中山大学附属第一医院1996年1月至2005年1月收治的46例阴茎癌患者的临床资料进行回顾性分析,46例患者中鳞状细胞癌44例,Paget病1例,疣状癌1例,对其中23例肿大淋巴结进行活检。结果:39例行阴茎部分切除术,4例行阴茎全切加会阴部尿道造口术治疗,1例Paget病患者行病灶切除植皮术,2例未接受手术治疗。10例淋巴结活检阳性的患者中有9例行腹股沟淋巴结清扫术,5例行同期盆腔淋巴结清扫术。41例患者获定期随访1～10年,1年、2年、5年、10年生存率分别为95.1%、95.1%、82.9%、31.7%。术后病理证实有盆腔淋巴结转移者2例均在2年内死于肺转移。结论:阴茎部分切除术是治疗阴茎癌合理有效的方法,且应尽早手术治疗。淋巴结转移是影响阴茎癌预后的重要因素,有腹股沟淋巴结转移者应早期行淋巴结清扫术治疗,以提高治疗效果。有盆腔淋巴结转移者预后差。

BACKGROUD ＆ OBJECTIVE; Penile cancer is an uncommon malignancy, which is mainly treated by surgery, radiation and chemotherapy. This study was to investigate reasonable curative methods for penile cancer. METHODS. Medical records of 46 patients with penile cancer in the Department of Urology, The First Affiliated Hospital of Sun Yat-sen University between Jan. 1996 to Jan, 2005 were analyzed retrospectively. Forty-four patients had squamous cell carcinoma, one had Paget disease, and one had verrucous carcinoma. RESULTS： Thirty-nine patients received partial penectomy, four received total penectomy and perineal urethrostomy, one Paget disease patient received lesion resection and skin grafting, two patients did not receive surgery. Nine out of 10 patients with positive lymph node received ilioinguinal lymphadenectomy, and five received pelvic lymphadenectomy. Forty-one cases were regularly followed up for one to 10 years. The 1-, 2-, 5- and 10- year survival rates were 95.1%, 95.1%, 82.9% and 31.7%, respectively. Prognosis of patients with pelvic lymph node metastasis was poor. Two patients who had pelvic lymph node metastasis died of lung metastasis within two years after surgery. CONCLUSIONS： Partial penectomy is an appropriate and effective management for penile cancer. Lymph node metastasis is an important prognostic factor for penile cancer. Patients with ilioinguinal lymph node metastasis should receive lymphadenectomy as early as possible to improve the therapeutic effect. The prognosis is poor for patients with pelvic lymph node metastases.