[阴茎和阴囊佩吉特病的局部广泛切除与根治性切除的比较]
[Comparison of wide local excision and radical excision for Paget's disease involving the penis and scrotum].
作者信息
Meng Fanjun, Pu Yi, Chen Zhixing, Cen Ying, Chen Junjie
机构信息
Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jun 15;31(6):714-717. doi: 10.7507/1002-1892.201701070.
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 ( >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 ( <0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B ( <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 ( =-2.102, =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 ( =0.202, =0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B ( =-2.810, =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.
目的
通过与根治性切除术比较，评估阴茎及阴囊佩吉特病广泛局部切除术的有效性及优势。
方法
对2010年11月至2015年8月间符合纳入标准的41例阴茎及阴囊佩吉特病患者的临床资料进行回顾性分析。其中，14例行广泛局部切除术（A组），27例行根治性切除术（B组）。两组患者年龄、病程、病变部位比较，差异无统计学意义（>0.05）。记录并比较两组患者的复发率、手术时间、术中冰冻切片病理次数、住院时间、伤口愈合等级、外观及功能满意度。
结果
A组手术时间及住院时间均明显短于B组（<0.05）；A组术中冰冻切片病理次数明显少于B组（<0.05）。A组患者随访13至67个月（平均35.5个月），B组患者随访11至70个月（平均38.8个月）。A组伤口愈合A级、B级、C级分别为11例、2例、1例，B组分别为12例、7例、8例，两组比较差异有统计学意义（=-2.102，=0.036）。A组5年复发率为28.6%（4/14），B组为22.2%（6/27），差异无统计学意义（=0.202，=0.654）。A组外观及功能满意度评分明显高于B组（=-2.810，=0.008）。
结论
阴茎及阴囊佩吉特病病情进展缓慢，预后良好。广泛局部切除术能有效缓解症状，明显降低老年患者围手术期风险，且复发率无明显增加。
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