阴茎黑色素痣不同手术方法的临床疗效观察

Clinical observation of different surgical methods in the treatment of penile melanocytic nevus

目的总结阴茎黑色素痣的主要临床特征,对比不同手术方法治疗阴茎黑色素痣的临床疗效。方法回顾性分析自2015年9月至2019年1月收治的9例阴茎黑色素痣患者的临床资料,其中5例为阴茎分裂痣患者。阴茎龟头处黑色素痣面积为0.4 cm×0.5 cm^1.5 cm×2.0 cm,阴茎包皮处黑色素痣面积为0.5 cm×0.6 cm^1.5 m×2.0 cm。手术分别采用包皮内板游离移植法(1例)、直接切除缝合法(3例)、切除后创面换药法(5例)的方法,术中切除病变组织均送病理检查。结果手术前后BMSFI评分无差异。其中1例分裂痣患者采用包皮内板游离移植后皮片发生坏死,经二次清创术后创面愈合。切除创面换药法术后瘢痕挛缩、增生的风险较低。术后随访6~30个月,所有患者均无复发。结论采用切除后创面换药方法治疗阴茎黑色素痣,方法简单、安全、易于推广,患者对阴茎外观及功能均较满意,是治疗阴茎黑色素痣较理想的治疗方法之一。

Objective To summarize the main clinical features of penile melanocytic nevus and to compare the clinical efficacy of different surgical methods in the treatment of penile melanocytic nevus. Methods The medical records were retrospectively reviewed from our database to identify 9 patients with penile melanocytic nevus between September 2015 and January 2019. Five patients with divided nevus of penis were included in the present study. The area of melanocytic nevus on glans was from 0.4 cm×0.5 cm to 1.5 cm×2.0 cm and the prepuce was from 0.5 cm×0.6 cm to 1.5 cm×2.0 cm. Free grafting of internal plate of the prepuce(1 patient), direct excision combined with suture(3 patients) and excision combined with wound dressing change(5 patients) were performed, respectively. All lesions were sent to pathological examination. Results There was no significant difference in BMSFI score before and after the surgery. One patient with divided nevus underwent the free grafting of internal plate of the prepuce. The skin graft showed necrosis and healed after the second debridement. The risk of scar contracture and hyperplasia after excision combined with wound dressing change was low. All patients were followed up from 6 to 30 months and no recurrence appeared. Conclusion The application of excision combined with wound dressing change in the treatment of penile melanocytic nevus is simple, safe and easy to popularize. After long-term follow-up, patients are satisfied with the appearance and function of penis. It is an ideal method to treat penile melanocytic nevus.