摘要
目的探讨术后复发的大面积乳房外Paget病的手术方法,以期提高对其手术治疗的认识。方法回顾性分析1例术后复发的大面积乳房外Paget病患者的治疗过程,并文献复习。结果64岁男性患者无诱因下出现阴囊右部红肿,进行性加重,伴糜烂,部分皮肤伴菜花样赘生物,累及阴茎,至阴茎根部4cm处,同侧腹股沟可触及多个肿大的淋巴结。术前病理提示鳞状上皮中度不典型增生,局部重度不典型增生。入院后行外科手术治疗,并行双侧腹股沟淋巴结清扫,淋巴结术中冰冻提示良性,并予以皮瓣皮片修复后出院。患者术后3年发现移植区皮肤红肿潮湿,症状逐渐加重,再次入院治疗,行手术扩大切除同时行Ⅰ期皮瓣转移修复,术后予以封闭式负压引流(VSD)覆盖创面,术后待肉芽组织形成再行皮片移植,术后效果较好。结论术后复发的大面积乳房外Paget病手术可先行Ⅰ期手术切除加皮瓣转移,Ⅱ期手术植皮,术后效果好。
Objective To explore the surgical methods for recurring large-area extramammary Paget′s disease after operation, so as to improve the understanding of surgical treatment. Methods A retrospective analysis of the treatment process of a case of postoperative recurrence of large extramammary Paget disease and literature review. Results The patient, male, 64 years old, had no bad habits. There was redness and swelling of the right part of the scrotum without any precipitating cause, which was progressively worsening, accompanied by erosion, and part of the skin was accompanied by cauliflower-like vegetation, involving the penis, reaching 4 cm from the base of the penis. Multiple enlarged lymph nodes are palpable in the ipsilateral groin. Preoperative pathology showed moderate dysplasia of squamous epithelium and severe local dysplasia. Surgery was performed after admission, and bilateral inguinal lymph node dissection was performed. The lymph nodes were frozen during the operation, indicating benignity. The skin flaps were repaired and then discharged. The patient found that the skin in the transplantation area was swollen and moist 3 years after the operation, and the symptoms gradually worsened, and he was admitted to the hospital again. At the same time, extended surgical resection and stage Ⅰ flap transfer repair were performed. VSD was applied to cover the wound after the operation. After the formation of granulation tissue, the skin graft was performed. The postoperative effect was good. Conclusions Stage Ⅰ surgical resection and skin flap transfer can be performed for the recurrence of large area extramammary Paget after operation, and skin grafting at stage Ⅱ surgical can achieve good postoperative results.
作者
黄嘉豪
王坚
石天昊
冯燕飞
黄文杰
黄晓军
吕伯东
HUANG Jiahao;WANG Jian;SHI Tianhao;FENG Yanfei;HUANG Wenjie;HUANG Xiaojun;LYU Bodong(The Second Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;Department of Urology,the Second Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China;Zhejiang Prouincial Key Laboratory of Traditional Chinese Medicine/Laboratory of Andrology,Hangzhou 310053,Zhejiang,China;Research lnstitute of Urology and Andrology,Zhejiang Chinese Medical University,Hanghou 310053,Zhejiang,China;Department of Urology,the Second Affiliated Hospitalof Zhejiang University,Hangzhou 310009,Zhejiang,China)
出处
《中国性科学》
2021年第12期126-129,共4页
Chinese Journal of Human Sexuality
基金
国家自然科学基金面上项目(82074433)。
关键词
乳房外PAGET病
大面积
复发
植皮
手术治疗
Extramammary Paget's disease
Large area
Recurrence
Skin graft
Surgical treatment
