阴茎癌84例临床分析

目的 寻求阴茎癌合理有效的治疗方法。方法 总结分析了阴茎癌84例,鳞状细胞癌80例,乳头状瘤恶变4例。行阴茎肿瘤局部切除3例,阴茎部分切除术67例,阴茎全切并尿道会阴部造口术14例,17例有癌转移者行腹股沟淋巴清扫术。结果 76例获得随访,行阴茎部分切除术者5年和8年以上生存率分别为88.5％和82.2％,行阴茎全切术者5年和8年生存率分别为81.8％和81.8％;二者比较无显著性差异(p>0.05)。无淋巴结转移者5年和8年生存率分别为88.3％和81.6％,有淋巴结转移者则分别为62.5％和50.0％,二者比较有显著性差异(p<0.05)。结论 包茎和包皮过长是导致阴茎癌的主要因素。合理选择适应症行阴茎部分切除术治疗有效,其5a和8a生存率较高,有淋巴结转移预后差。有明显转移者,应积极行腹股沟淋巴结清扫术。     

33例阴茎癌的外科治疗分析

目的:探讨阴茎癌合理的外科治疗方法。方法:回顾性分析2008年1月~2012年12月间收治的33例阴茎癌患者的临床资料:鳞状细胞癌患者31例,疣状癌患者2例。5例行阴茎局部病变切除术,26例行阴茎部分切除术,2例行阴茎全切加会阴部尿道造口术。行腹股沟淋巴结清扫术20例,其中7例行双侧改良根治性腹股沟淋巴结清扫术,10例行一侧改良根治性腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术,3例行髂腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术。结果:33例患者定期随访1~5年,平均随访31个月,1年生存率为93.9%(31/33),2年为87.9%(29/33),5年为72.7%(24/33)。本组6例T1G2期以上阴茎癌患者行预防性腹股沟淋巴结清扫术,术后随访生存率为83%(5/6);而另有14例未行腹股沟淋巴结清扫术,术后随访死亡7例,生存率为50%(7/14)。在33例阴茎癌患者中,9例可扪及单侧或双侧腹股沟淋巴结,行双侧淋巴结活检,有6例为阳性,阳性率高达66.7%(6/9);但有3例阴性患者随访过程中出现腹股沟淋巴结转移,假阴性率为13%(3/23)。有7例伴髂、腹股沟淋巴结转移,随访期间7例患者全部死亡,结论:对阴茎癌患者,合理地选择手术方式切除肿瘤,并合适地选择行腹股沟淋巴结清扫的时机和方式,采用一定的手术技巧,可明显提高患者生存率并减少并发症。     

阴茎癌 215例临床分析

目的：探讨阴茎癌有效合理的治疗方法。方法：回顾性分析215你阴茎癌患者临床资料，211例行手术治疗，其中行阴茎部分切除术142例，阴茎全切除并尿道会阴部造口术69例，同时或二期行双侧腹股沟淋巴结清扫术64例。结果：146例获得随访。行阴茎部分切除术者5年和10年生存率分别为80.7%和64.4%。行阴茎全切除术是治疗Ⅰ、Ⅱ期阴茎癌十分合理和有效的方法，其生存率与阴茎全切除术无差别，阴茎癌预后与肿瘤分期密切相关。患者宜及早进行相应的手术治疗。     

腹股沟淋巴结清扫术在阴茎癌治疗中的作用

目的:探讨腹股沟淋巴结清扫术在阴茎癌治疗中的作用,为临床治疗阴茎癌提供成功案例.方法:对15例阴茎癌而接受腹股沟淋巴结清扫术的患者进行临床治疗观察.结果:术后病理检查均发现13例有腹股沟淋巴结转移,2例有淋巴结增大,均诊断为鳞状细胞癌.结论:阴茎癌容易并发腹股沟淋巴结转移,建议常规行预防性腹股沟淋巴结清扫术,这有助于提高患者的生存率.     

82例阴茎鳞状细胞癌临床诊断与治疗

目的：提高阴茎鳞状细胞癌的诊断和治疗水平。方法：回顾性分析1980-2005年82例阴茎鳞状细胞癌患者临床资料,结合文献复习进行讨论。结果：77例病例行手术治疗,其中阴茎部分切除术64例,阴茎全切术13例。阴茎切除加髂腹股沟淋巴结清扫14例（腹股沟淋巴结均为阳性,髂淋巴结均为阴性）。放疗3例,化疗1例,放化疗联合治疗1例。71例患者随访1～10年,5例1年内死亡,17例2～5年内死亡,49例生存5年以上,占69％,其中34例生存10年,占48％,11例失访。结论：包茎、包皮过长是阴茎鳞状细胞癌的重要诱因;HPV感染可能与阴茎鳞状细胞癌发生有关。外科手术治疗是目前治疗阴茎鳞状细胞癌的有效方法;淋巴结清扫范围应采用由浅至深逐级切除的方式;放、化疗及联合治疗疗效尚不确切。     

58例阴茎鳞状细胞癌治疗的临床分析

目的:提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法:回顾分析58例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果:按照Jackson分期,Ⅰ期25例,Ⅱ期18例,Ⅲ期11例,Ⅳ期4例。53例行手术治疗;行阴茎肿瘤局部切除及阴茎癌部分切除43例;阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术10例(腹股沟淋巴结均阳性,髂淋巴结阳性1例)。术前新辅助治疗(热疗加化疗)联合术后化疗37例,仅术后化疗12例,单纯手术治疗4例;5例未手术治疗患者行化疗和/或放疗。48例随访2~5年,4例行阴茎部分切除者2年内复发,4例2年内死亡,7例2~5年内死亡,2年生存率为91.7%,5年生存率为77.1%,10例失访或随访期未满2~5年。结论:外科手术治疗、术前新辅助治疗联合术后化疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结的清扫根据临床分级具体处理,手术联合术前新辅助治疗及术后化、放疗是否可减少复发及提高生存率,还需进一步研究。     

阴茎癌68例临床分析

目的：寻求荫茎癌有效合理的治疗方法。方法：总结分析了阴茎癌６８例，其中鳞状细胞癌５８例，乳头状瘤恶变１０便。行阴茎部分切除术５７例，阴茎全切除并阴道会阴部造口术１１例，随后行双侧腹股沟淋巴表主６例。结果 ：４６例获得随访，行阴茎部分切除术者５年和１０年以上生存率分别为８７．７％和８２．２％，行阴茎全切除术者５年和１０年生存庞分别为８５．８％和８０．４％，二者比较无显著性差异。结论：包茎、包皮过长及     

阴茎癌腹股沟淋巴结转移行术前新辅助化疗的临床疗效分析

目的探讨阴茎癌腹股沟淋巴结转移行术前新辅助化疗的临床疗效。方法回顾性分析2001年至2008年收治的13例接受术前新辅助化疗及手术治疗的阴茎癌腹股沟淋巴结转移病例的临床及随访资料,并进行生存分析。结果阴茎癌淋巴结转移13例,均行以顺铂、博来霉素、甲氨蝶呤为主要方案的术前新辅助化疗,其后11例行阴茎部分切除术+单侧或双侧腹股沟淋巴结清扫术,2例行局部放射治疗。从阴茎癌腹股沟淋巴结转移治疗后开始计算生存率,1例失随访。1、2、5年生存率分别为75.0%(9/12)、66.7%(8/12)和41.7%(5/12)。结论对阴茎癌腹股沟淋巴结转移患者采用新辅助化疗结合手术治疗是一种有效的治疗手段。     

阴茎癌切除同期行改良根治性腹股沟淋巴结清扫术的可行性研究

目的 探讨同期行阴茎癌原发病灶切除和改良根治性腹股沟淋巴结清扫术的可行性.方法 回顾性分析2002年6月至2010年6月55例同期行阴茎癌切除和改良根治性腹股沟淋巴结清扫术的患者资料.患者年龄27～73岁,平均49岁.行同期改良根治性腹股沟淋巴结清扫术107侧,1侧行腹股沟淋巴结清扫术之前曾行大隐静脉抽出术,2侧行同期经典根治性腹股沟淋巴结清扫术. 结果 107侧改良根治性腹股沟淋巴结清扫术后发生切口感染1侧次(0.9％),下肢淋巴水肿18侧次(16.8％),皮瓣坏死6侧次(5.6％).每侧切除淋巴结3 ～23枚,平均11枚.3年总生存率为84％. 结论 阴茎癌切除同期行改良根治性腹股沟淋巴结清扫术可保证控瘤效果,不增加手术后并发症,是适合阴茎癌患者的治疗策略.     

包皮环切术后发生阴茎鳞状细胞癌17例报道

目的:分析包皮环切术后发生的阴茎癌的诊治。方法:回顾性分析我院1997年1月~2004年12月行包皮环切术后1个月~16年发生阴茎癌17例患者的临床资料。结果:本组患者中术后1~12个月发现阴茎癌者11例,术后3~16年发现者6例;16例行阴茎部分切除术+腹股沟淋巴结活检术,1例行扩大包皮环切术后复发相继行阴茎部分切除、全切术。复发的1例死亡,其余16例存活至今。结论:成年人行包皮环切术后仍有发生阴茎癌可能,对伴有包皮炎症、溃疡等病变的患者行包皮环切术应常规行病理检查,术后需密切随访,阴茎部分切除术是治疗早期阴茎鳞状细胞癌有效的方法,术中有必要行前哨淋巴结活检。     

Two cases of giant condyloma with malignant degeneration

We report two rare cases of giant condyloma with malignant degeneration. Case 1: A 70-year-old male noticed a small nodule on his glans penis 5 years ago that had recently grown larger and larger. After admission, the biopsy of the mass revealed giant condyloma with malignant degeneration. Partial amputation of the penis was performed. Meatoplasty was performed by Whisnant 's procedure. Case 2: A 49-year-old male had received exstirpation of the condyloma of the penis eleven years earlier. Local recurrence and exstirpation were repeated. In June 1981, the mass was diagnosed as giant condyloma. In December malignant degeneration was suspected. In 1982, radiation therapy failed to reduce the mass and it made an ulcer on the penis. Total amputation of the penis was performed. The pathological diagnosis was invasive keratinizing squamous cell carcinoma. Meatoplasty was performed, applying Toyoda 's ureterocutaneostomy and Abercrombie 's procedure. Though giant condyloma is pathologically benign, in many cases it is clinically indistinguishable from squamous cell carcinoma and may have a malignant potential like our cases. It may be concluded that giant condyloma should be treated as malignant and that partial or total penectomy may be the best treatment because conservative treatment including local excision is not effective.     

Penis conserving treatment for T1 and T2 penile carcinoma: clinical implications of a local recurrence

PURPOSE: We evaluated our experience with primary tumor treatment for T1 and T2 penile squamous cell carcinoma and discussed the clinical implications of a local recurrence. MATERIALS AND METHODS: The primary tumor treatment and clinical course of 257 patients with T1 or T2 penile carcinoma were evaluated. Primary tumor treatment consisted of penis preservation in 157 and (partial) amputation in 100 patients. Median followup was 106 months (range 16 to 541). RESULTS: The 5-year local recurrence-free estimate after penis preservation was similar for T1 and T2 tumors (log rank test p = 0.1) and overall 63% (CI: 54%-72%) compared to 88% (CI: 81%-95%) for partial amputation (log rank test p = 0.0003). In case of a local recurrence after penis preserving treatment, local control could be achieved in 94% (51 of 54) of cases. Of patients with T1 tumors treated with penis preservation, regional recurrence developed in 33% (7 of 21) of patients with local recurrence compared to only 6% (3 of 47) of patients without local recurrences (Fisher's exact test p = 0.005). Of the patients with T2 tumors treated with penis preservation, regional recurrence developed in 27% (9 of 33) of patients with local recurrence compared to 27% (12 of 45) of patients without local recurrence (chi-square test p = 0.96). Of 10 patients with a local recurrence after partial amputation of the penis, 9 died of disease. CONCLUSIONS: The incidence of local recurrence increases with penis preservation but can be treated accurately in most cases. Local recurrences can signify lymphatic regional spread. A local recurrence after penile amputation carries a poor prognosis.     

Carcinoma in situ of the penis rapidly progressing after carbon dioxide laser treatment

Laser treatment is considered to be effective in treating carcinoma in situ of the penis. We, however, report a case with carcinoma in situ of the penis which developed invasive carcinoma and inguinal lymphnode metastases only 6 months after the laser treatment. A 74-year-old man with pseudophimosis presented with redness of the glans penis. A physical examination revealed thick erythema, 12 millimeters in diameter, around the external urethral meatus. Histologically, biopsy revealed squamous cell carcinoma in situ. No metastasis was suspected by physical examination and imaging studies. Although the lesion appeared to slightly extend into the urethra, it was primarily treated with the CO2 laser. Six months after the treatment, however, local recurrence was confirmed by the touch smear cytology, resulting in the partial amputation of the penis. The histopathological examination revealed subepithelial and marked lymphatic invasion of the tumor and positive margin in the urethral stump (squamous cell carcinoma in situ). Further, since bilateral superficial inguinal lymphnode swelling appeared, total amputation of the penis with perineal urethrotomy and pelvic/inguinal lymphnode dissection was performed subsequently. The metastases to bilateral inguinal lymphnodes were confirmed histologically. The patient received adjuvant chemotherapy and has been alive and well without evidence of disease 40 months after the initial treatment.     

Resurfacing and reconstruction of the glans penis

OBJECTIVES: To describe the techniques and results of surgical reconstruction of glans penis lesions. METHODS: Seventeen patients (mean age: 53.2 yr) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was one Zoon's balanitis, four lichen sclerosus, one carcinoma in situ, five squamous cell carcinomas, and six squamous cell carcinomas associated with lichen sclerosus. Five cases were treated by glans skinning and resurfacing; five cases by glans amputation and reconstruction of the neoglans, and seven cases by partial penile amputation and reconstruction of the neoglans. Glans resurfacing and reconstruction were performed with the use of a skin graft harvested from the thigh. RESULTS: The mean follow-up was 32 mo. All patients were free of local premalignant/malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neoglans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/penile amputation. CONCLUSIONS: In selected cases of benign, premalignant or malignant penile lesions, glans resurfacing or reconstruction can ensure a normal appearing and functional penis, without jeopardizing cancer control.     

A case of Buschke-Loewenstein tumor

A 67-year-old man with a tumor resembling carcinoma of the penis was seen at our Department. The tumor appeared clinically to be malignant and partial amputation of the penis was therefore performed. But biopsy specimens from parts of the mass were benign and histological examination revealed Buschke-Loewenstein tumor.     

Penile amputations for the management of primary carcinoma of the penis.

In conclusion, a carefully planned and timed surgical extirpation of the primary carcinoma of the penis should eliminate the possibility of local recurrence. The decision between partial or total amputation of the penis is based on the site and extent of the primary tumor. The decision must not compromise the goal of complete clearance of the primary tumor.     

Carcinoma of penis treated with neodymium YAG laser

Sixteen men with squamous cell carcinoma of the penis were treated primarily with the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Five patients had TIS, 9 had T1 tumors, and 2 had T2 carcinoma. All patients had refused traditional therapy of partial penectomy and gave informed consent as to the investigational nature of the Nd:YAG laser photoradiation therapy. Circumcisions and deep tissue biopsies were performed on all patients prior to tumoricidal neodymium photoradiation treatment. The patients were followed from twelve to thirty-six months. At follow-up, 5 patients with TIS had no evidence of recurrent cancer. Of the 9 patients with T1 squamous cell carcinoma of the penis, 6 (67%) were tumor-free at a mean follow-up of twenty-six months. The 2 men with T2 carcinoma of the penis had reduction of the tumor mass but were not cured. The obvious advantage of the Nd:YAG laser in treating carcinoma of the penis is preservation of the penis eliminating disfiguring amputation.     

Subtotal amputation for carcinoma of the penis with reconstruction of penile stump.

Partial and total amputation are well-accepted procedures for the surgical treatment of carcinoma of the penis. In certain cases after adequate amputation the residual penile stump is too small from the penoscrotal junction to offer useful function, and a total amputation is therefore usually performed. In such cases a subtotal amputation with reconstruction of the penile stump avoids a perineal urethrostomy and permits micturition in the erect posture.