推进皮瓣转移结合阴茎阴囊转位术在阴茎阴囊湿疹样癌中的应用

Application of advancement flap transfer combined with penoscrotal transposition in penoscrotal Paget's disease

摘要

目的 分析推进皮瓣转移结合阴茎阴囊转位术治疗阴茎阴囊湿疹样癌的疗效，以供临床参考。方法 回顾性分析2019年1月-2024年12月于河北医科大学第二医院收治的8例阴茎阴囊湿疹样癌患者的临床资料，所有患者接受了局部扩大切除术及推进皮瓣转移结合阴茎阴囊转位术治疗。分析统计患者的手术时年龄、手术时间、住院天数和术后复发等情况。结果 8例患者平均手术时年龄（64.00±8.31）岁、平均手术时间（106.67±60.10）min、平均住院天数（6.89±3.18）d，术后切口均愈合良好，术后阴茎阴囊皮肤无明显牵扯不适。术后至少随访1年，其中1例切缘阳性患者术后局部复发，再次予以手术切除，术后仍存在切缘阳性，予以放射治疗，随访至今无复发，其余7例患者无复发。结论 局部扩大切除术是目前临床治疗阴茎阴囊湿疹样癌的有效方法，对于病灶范围较大者，可选择推进皮瓣转移结合阴茎阴囊转位术重建会阴部皮肤。该术式手术操作简单、皮瓣血运好、术后并发症少，是阴茎、阴囊大范围病灶切除后覆盖创面的有效方法之一。

Abstract

Objective To analyze the efficacy of advancement flap transfer combined with penoscrotal transposition in the treatment of penoscrotal Paget's disease (PPD), so as to provide reference for clinical practice. Methods Clinical data of 8 PPD patients admitted to the Second Hospital of Hebei Medical University during Jan.2019 and Dec.2024 were retrospectively analyzed. All patients underwent local extended resection combined with advancement flap transfer and penoscrotal transposition. Age at operation, operation time, length of hospital stay and postoperative recurrence rate were statistically analyzed. Results The mean age at operation was (64.00±8.31) years, mean operation time (106.67±60.10) minutes, and length of hospital stay (6.89±3.18) days. All incisions healed well postoperatively, with no obvious traction discomfort of the penile and scrotal skin. All patients were followed up for at least 1 year. Local recurrence occurred in 1 patient with positive surgical margins, who underwent a second resection; since the surgical margins were still positive, radiotherapy was conducted, and no recurrence was found during follow-up. No recurrence was observed in the other 7 patients. Conclusion Local extended resection is an effective technique for treating PPD. For patients with extensive lesions, advancement flap transfer combined with penoscrotal transposition serves as an effective treatment for reconstructing perineal skin. This procedure is simple to perform, ensures good flap blood supply, and is associated with few postoperative complications. It is an effective method for covering defects after extensive resection of penile and scrotal lesions and is worthy of widespread application.

关键词

阴茎阴囊湿疹样癌 / 推进皮瓣转移 / 阴茎阴囊转位术

Key words

penoscrotal Paget's disease / advancement flap transfer / penoscrotal transposition

参考文献

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基金资助

河北省2024年度医学科学研究课题计划(20240110)