阴囊乳房外Paget病25例分析

Diagnosis,treatment and prognosis of scrotal Paget's disease:report of 25 cases

目的：探讨阴囊乳房外Paget病的临床特征、诊断、治疗及其预后，提高诊治水平。方法：对25例阴囊乳房外Paget病患者的临床资料进行回顾性分析，全部患者先行皮损活检，后行术中快速冷冻切片辅助检查切缘的病灶根治性切除治疗；4例腹股沟淋巴结肿大患者加行术中快速淋巴结冷冻切片检查，其中3例证实为Paget细胞腹股沟淋巴结转移，1例为淋巴结炎．3例腹股沟淋巴结转移患者同时行同侧腹股沟淋巴结清扫术。结果：术后23例患者I期愈合，2例患者Ⅱ期愈合。术后定期随访9-66个月，复发7例，复发率为28％。其中5例局部复发，接受再次手术治疗，至今存活；1例2年后发现腹股沟淋巴结转移．再次手术治疗3年后又出现同侧腹股沟淋巴结转移，再次手术后存活至今；1例初诊伴腹股沟淋巴结转移患者2年后因肺转移死亡。结论：活检是诊断阴囊乳房外Paget病重要方法，该病的首选治疗方法为术中快速切片辅助检查切缘的病灶根治性手术切除，病理分期对患者病情的发展及预后起重要作用。

Objective： To study the clinical features as well as diagnosis, treatment and prognosis of scrotal Paget＇s disease. Methods： We retrospectively analyzed the clinical data of 25 cases of scrotal Paget＇s disease diagnosed and treated in our hospital. All cases were biopsied around the lesion, then made frozen section to check cutting edge in the operation. Three patients showed enlarged inguinal lymph nodes in the same side, and one in both side. Three cases were confirmed by biop- sy and treated by surgery and one was lymphnoditis given anti-inflammatory therapy. Results： twenty three cases were I stage healing and the others were II stage healing. All cases were followed up for 6 months to 66 months and Seven cases recurred, the recurrence rate was 28%. Five cases with locally recurred are still alive after second operation. One case in- volved inguinal lymph node metastasis after two years and five years post-operation respectively and was given therapy every metastasis. One case was died of lung metastasis after inguinal lymph node dissection two years later. Conclusions： Biopsy is proved to be important for the diagnosis of scrotal Paget＇ s disease. Its preferred treatment is radical excision. And the in- tra-operative rapid frozen section should be made to check the cutting edge. Pathological stage is of importance to the progress and prognosis of patients.