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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 curative effect of partial enucleation of penis scrotum Paget by comparing with radical resection. Methods The clinical data of 41 cases of penile scrotum Paget patients who were admitted to our hospital from November 2010 to August 2015 were retrospectively analyzed. Among them, 14 patients underwent local enlargement resection (group A) and 27 patients underwent radical resection Group B). The two groups of patients age, duration, lesion location and other general information, the difference was not statistically significant (P> 0.05), comparable. Record and compare the recurrence rate, operation time, the number of intraoperative rapid frozen pathological examination, postoperative hospital stay, wound healing grade, patient function and appearance of self-rated satisfaction ratings. Results Compared with group B, the operation time and postoperative hospital stay in group A were significantly shortened, and the number of rapid frozen pathological examination decreased during operation. The difference was statistically significant (P <0.05). The patients in both groups were followed up. The follow-up time in group A was 13 to 67 months (average 35.5 months). The patients in group B were 11 to 70 months (mean, 38.8 months). In group A, grade A was found in 11 cases, grade B in 2, grade C in 1, group B in 12, 7 and 8 cases, respectively (P = 0.036, Z = -2.102, P = . Within 5 years after operation, 4 cases (28.6%) in group A and 6 cases (22.2%) in group B had no recurrence (χ2 = 0.202, P = 0.654). At the final follow-up, the scores of appearance and functional self-rated satisfaction of patients in group A were significantly higher than those in group B, with significant difference (t = -2.810, P = 0.008). Conclusion The Paget’s disease of penis and scrotum is progressing slowly and the prognosis is good. The local enlargement resection can effectively remove the symptoms and reduce the perioperative risk in the elderly patients. The postoperative recurrence rate is not significantly higher than radical resection.