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目的探讨阴囊Paget病的临床特点及诊治方法。方法纳入2008年-2013年期间经病理证实的18例阴囊Paget病患者,年龄55~81岁,平均69岁。病程9个月~18年,平均6年3个月。最主要的临床表现为瘙痒(94.4%),其他症状体征包括渗液(66.7%)、疼痛(11.1%)、脱屑(5.6%)。所有患者均行病灶扩大切除术。结果随访时间8~52个月,平均34个月。术后病理检查提示4例患者阴茎切缘有病灶累及,其中1例术后出现局部复发,其余14例完全切除的患者均无局部病灶复发。1例病理检查提示合并浸润性腺癌,侵达皮下脂肪组织层,术后20个月出现腹股沟淋巴结转移,1例病理检查提示低分化腺癌伴表皮派杰病形成,并侵及真皮深层,术后18个月肝肺转移。结论阴囊Paget病多见于老年患者,症状以瘙痒为主。多有就诊延迟现象,应及早行病理检查明确诊断。治疗以手术为主,伴有浸润性病变、合并腺癌者预后较差。
Objective To investigate the clinical features and diagnosis and treatment of scrotal Paget disease. Methods 18 cases of scrotum Paget disease confirmed by pathology between 2008 and 2013 were enrolled. The patients were 55 to 81 years old with an average of 69 years. Course of 9 months to 18 years, an average of 6 years and 3 months. The main clinical manifestations were pruritus (94.4%). Other symptoms and signs included exudate (66.7%), pain (11.1%) and desquamation (5.6%). All patients underwent focal resection. Results The follow-up time was 8 to 52 months with an average of 34 months. Postoperative pathological examination showed lesions of penis margins were involved in 4 cases, of which 1 case had local recurrence after operation, and no recurrence was found in the remaining 14 cases of complete resection. A case of pathological examination revealed invasive adenocarcinoma, invasion of subcutaneous adipose tissue layer, inguinal lymph node metastasis 20 months after surgery, 1 case of pathological examination showed poorly differentiated adenocarcinoma with epidermal Peijie disease, and invasion of deep dermis, surgery Liver and lung metastases after 18 months. Conclusion Scrotum Paget's disease is more common in elderly patients and its symptoms are mainly pruritus. More treatment delay, pathological examination should be a clear diagnosis. Surgical treatment-based, with invasive lesions, with poor prognosis of adenocarcinoma.