Vignes S, Trévidic P
Unité de Lymphologie, Hôpital Cognacq-Jay, Site Broussais, Paris.
Ann Dermatol Venereol. 2005 Jan;132(1):21-5. doi: 10.1016/s0151-9638(05)79190-0.
The aim of this retrospective study was to describe the main characteristics and treatment of male external genitalia lymphedema.
From 1987 to 2003, all patients seen in a single hospital for lymphedema of male external genitalia were included. For each patient, the following characteristics were recorded: primary or secondary lymphedema, cause of secondary form, date of onset of lymphedema, associated lower limb lymphedema, clinical signs, and complications. In the primary forms, lower limb lymphoscintigraphy was performed. Specific surgery was proposed in all cases of symptomatic lymphedema (circumcision, scrotum and/or penile cutaneous excision).
Thirty-three patients with lymphedema of external genitalia (17 primary, 16 secondary) were recruited. Two primary lymphedema were congenital, one isolated. Mean age +/- SD of the onset of the 15 other primary genital lymphedema was 23.4 +/- 17.5 years, always after the appearance of lower limb lymphedema. Sixteen men had secondary lymphedema (bladder, prostate, or rectum cancer, Hodgkin or non-Hodgkin lymphoma, aorto-bifemoral bypass grafting, biopsy or curretage of inguinal nodes). Secondary genitalia lymphedema was not associated with lower limb lymphedema in two cases and, in the others it occurred 66 +/- 122 months after (n=11), at the same time (n=2) or before lower limb lymphedema (n=1). Clinically, we noted genitalia heaviness (n=31), lower limb lymphedema (n=30), vaginal hydrocele (n=13), impaired miction due to prepucial swelling (n=10), leakage of lymphatic fluid (n=10). Lower limb lymphedema was complicated by at least one erysipelas (n=20), spreading to the external genitalia (n=4). In primary forms, lymphoscintigraphy showed ipsilateral hypoplasia of inguinal nodes in lower limb lymphedema (n=14) and/or external genitalia backflow (n=7). Surgical treatment was performed in 17 cases (11 primary, 6 secondary) with good results after 21 months' median follow up (1 month-10 years). Two patients died of cancer. One secondary lymphedema improved spontaneously and one disappeared after withdrawal of lower limb pneumatic compression.
Lymphedema of external genitalia is responsible for discomfort and local complications. Surgical treatment is the main procedure of this disorder.
本回顾性研究旨在描述男性外生殖器淋巴水肿的主要特征及治疗方法。
纳入1987年至2003年间在一家医院就诊的所有男性外生殖器淋巴水肿患者。记录每位患者的以下特征：原发性或继发性淋巴水肿、继发性淋巴水肿的病因、淋巴水肿的发病日期、合并的下肢淋巴水肿、临床体征及并发症。对于原发性淋巴水肿患者，进行了下肢淋巴闪烁造影。对所有有症状的淋巴水肿病例（包皮环切术、阴囊和/或阴茎皮肤切除术）均建议进行特定手术。
招募了33例外生殖器淋巴水肿患者（17例原发性，16例继发性）。2例原发性淋巴水肿为先天性，1例为孤立性。其他15例原发性生殖器淋巴水肿发病时的平均年龄±标准差为23.4±17.5岁，均在下肢淋巴水肿出现之后。16例男性有继发性淋巴水肿（膀胱癌、前列腺癌或直肠癌、霍奇金淋巴瘤或非霍奇金淋巴瘤、主动脉-双股动脉搭桥术、腹股沟淋巴结活检或刮除术）。2例继发性生殖器淋巴水肿与下肢淋巴水肿无关，其他病例中，继发性生殖器淋巴水肿在下肢淋巴水肿之后66±122个月出现（n = 11）、与下肢淋巴水肿同时出现（n = 2）或在下肢淋巴水肿之前出现（n = 1）。临床上，我们注意到生殖器沉重感（n = 31）、下肢淋巴水肿（n = 30）、鞘膜积液（n = 13）、因包皮肿胀导致排尿困难（n = 10）、淋巴液渗漏（n = 10）。下肢淋巴水肿至少合并一次丹毒（n = 20），其中4例蔓延至外生殖器。在原发性淋巴水肿病例中，淋巴闪烁造影显示下肢淋巴水肿患者腹股沟淋巴结同侧发育不全（n = 14）和/或外生殖器逆流（n = 7）。17例患者（11例原发性，6例继发性）接受了手术治疗，中位随访21个月（1个月至10年）后效果良好。2例患者死于癌症。1例继发性淋巴水肿自行改善，1例在停止下肢气压治疗后消失。
外生殖器淋巴水肿会导致不适和局部并发症。手术治疗是该疾病的主要治疗方法。
