Magoha G A
Department of Surgery, College of Health Sciences, University of Nairobi, Kenya.
East Afr Med J. 1995 Sep;72(9):547-50.
Partial penectomy is effective in the treatment of T1 and T2 penile carcinoma with 80% five-year survival rates in the absence of inguinal metastases, and the residual stump is serviceable for upright micturition and sexual function. The use of micrographic surgery first introduced by Mohs in 1941 for small distally located lesions of upto one centimetre diametre achieves results comparable to partial penectomy. Carbon dioxide and Neodymium-Yag lasers have also been used in the treatment of T1 and T2 tumours with 89% five year survival rates. Radiotherapy is also ideal for the treatment of T1 and T2 primary penile carcinoma because failure is corrected with salvage partial penectomy. In T3 disease with extensive local growth total penectomy and removal of scrotal contents followed by perineal reconstruction with scrotal flap is associated with 90% five year survival rates. In advanced T4 tumours with fixed inguinal nodes (N3), hemipelvectomy or hemicorporectomy with combination cytotoxic chemotherapy is considered in selected cases. Various cytotoxic agents like bleomycin, vincristine and methotrexate have been used in adjuvant and neoadjuvant therapy with mixed results. Pre operative radiotherapy is useful in the treatment of patients with metastatic groin lymph nodes of greater than or equal to 4 cm in size. Radiotherapy also provides effective palliation in patients with advanced regional and/or distant metastases. Groin block dissection is commonly performed to treat groin node metastasis and to stage nodal disease in patients with clinically negative groins. The procedure is however associated with significant morbidity resulting in complications such as wound infection and skin necrosis leading to wound breakdown and lymphoedema.(ABSTRACT TRUNCATED AT 250 WORDS)
部分阴茎切除术对于治疗T1和T2期阴茎癌有效，在无腹股沟转移的情况下，五年生存率达80%，且残留残端可用于站立排尿和维持性功能。1941年莫氏首次引入的显微外科手术用于治疗直径达1厘米的远端小病灶，其效果与部分阴茎切除术相当。二氧化碳激光和钕钇铝石榴石激光也已用于治疗T1和T2期肿瘤，五年生存率为89%。放射治疗也是T1和T2期原发性阴茎癌的理想治疗方法，因为可通过挽救性部分阴茎切除术纠正治疗失败。对于T3期伴有广泛局部生长的疾病，全阴茎切除术并切除阴囊内容物，随后用阴囊皮瓣进行会阴重建，五年生存率为90%。对于伴有固定腹股沟淋巴结（N3）的晚期T4肿瘤，在某些选定病例中考虑进行半侧骨盆切除术或半体切除术并联合细胞毒性化疗。各种细胞毒性药物如博来霉素、长春新碱和甲氨蝶呤已用于辅助和新辅助治疗，但结果不一。术前放疗对治疗腹股沟转移性淋巴结大小大于或等于4厘米的患者有用。放疗也能有效缓解晚期局部和/或远处转移患者的症状。腹股沟淋巴结清扫术通常用于治疗腹股沟淋巴结转移，并对临床腹股沟阴性的患者进行淋巴结分期。然而，该手术会导致显著的发病率，引发诸如伤口感染和皮肤坏死等并发症，进而导致伤口裂开和淋巴水肿。（摘要截断于250字）
