中国修复重建外科杂志

中国修复重建外科杂志

阴茎阴囊 Paget 病局部扩大切除术与根治性切除术的比较研究

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目的 通过与根治性切除术比较,评价阴茎阴囊 Paget 病局部扩大切除术的疗效。 方法 回顾性分析 2010 年 11 月—2015 年 8 月收治并符合选择标准的 41 例阴茎阴囊 Paget 病患者临床资料,其中 14 例采用局部扩大切除术(A 组),27 例采用根治性切除术(B 组)。两组患者年龄、病程、病损部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组复发率、手术时间、术中快速冰冻病理检查次数、术后住院时间、创面愈合分级、患者功能及外观自评满意度评分。 结果 与 B 组比较,A 组手术时间、术后住院时间均显著缩短,术中快速冰冻病理检查次数减少,比较差异均有统计学意义(P<0.05)。两组患者均获随访,A 组随访时间为 13~67 个月,平均 35.5 个月;B 组 11~70 个月,平均 38.8 个月。A 组创面甲级愈合 11 例、乙级愈合 2 例、丙级愈合 1 例,B 组分别为 12、7、8 例,两组比较差异有统计学意义(Z=–2.102,P=0.036)。术后 5 年内 A 组复发 4 例(28.6%),B 组复发 6 例(22.2%),比较差异无统计学意义(χ2=0.202,P=0.654)。末次随访时,A 组患者外观及功能自评满意度评分显著高于 B 组,比较差异有统计学意义(t=–2.810,P=0.008)。 结论 阴茎阴囊 Paget 病进展缓慢,预后良好,局部扩大切除术可有效去除症状,降低老年患者围手术期风险,且术后复发率较根治性切除术未明显升高。

Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.

关键词: 阴茎阴囊 Paget 病; 局部扩大切除术; 根治性切除术; 复发率

Key words: Paget’s disease involving penis and scrotum; wide local excision; radical resection; recurrence rate

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