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。     

阴茎癌84例手术治疗分析

目的：探讨阴茎癌的手术方式与愈后的关系。方法：通过对84例阴茎癌的手术治疗及3--15a的随访。结果：随访76例，3a存活65．8％(50例)，5a存活38％(29例)，10a存活31．6％(24例)，15a存活率23．7％(18例)。结论：阴茎癌手术治疗时间与预后有密切关系；阴茎部分切除术应距肿瘤至少2cm以上断阴茎，淋巴结的清扫范围应根据临床和病理情况做具体处理。     

阴茎癌腹股沟淋巴结清扫术72例临床分析

术前对４７例腹股沟肿大的前哨淋巴结作了活检和穿刺涂片细胞学检查，发现１５例有癌转移，阳性率为３１．３％。术后清扫标本病检证实３２例前哨啉巴结阴性者，其它淋巴结构未见癌转移。提示，前哨啉巴结活检有其可靠性，可为发现阳性者及时提供清扫术的指征。     

101例阴茎癌治疗的回顾性分析

回顾分析曾经收治的101例阴茎癌的临床资料,全部病例均经手术治疗,随访78例,存活70例。作者认为,应及早进行相应的手术治疗,阴茎部分切除术以距肿瘤至少2cm以上切断阴茎为宜。并提出了淋巴结的处理原则。     

阴茎癌51例诊治体会

目的探讨阴茎癌有效合理的诊断及治疗方法。方法回顾性分析51例阴茎癌患者的临床资料,其中鳞状细胞癌44例,鳞状上皮乳头状瘤恶变7例。均行手术治疗,其中行单纯肿瘤切除＋包皮环切术2例,阴茎部分切除术36例,阴茎全切＋尿道会阴部造口术13例,行双侧腹股沟淋巴结清扫术11例。结果41例获得随访,行阴茎部分切除术者2年和5年生存率分别为83．3％和76．7％,行阴茎全切除术者2年和5年生存率分别为72．7％和63．6％。结论阴茎癌早期诊断并予以手术为主的治疗对于改善患者预后十分重要,证实有淋巴结转移者应积极行髂腹股沟淋巴结清扫术。     

阴茎部分切除联合阴茎延长术治疗阴茎癌

应用阴茎部分切除联合阴茎延长术治疗阴茎癌 2例 ,手术效果满意 ,阴茎延长 3～ 4cm。通过阴茎延长可避免阴茎全切 ,保留站立排尿功能 ,最大限度保留性器官 ,保留了患者性功能和提高生活质量 ,手术方法简单、安全 ,无并发症。     

腹股沟前哨淋巴结活检在阴茎癌治疗中的价值

目的 探讨腹股沟前哨淋巴结活检在阴茎癌手术治疗及二期髂腹股沟淋巴结清扫的意义. 方法 对阴茎癌患者在手术切除原发病灶的同时,行双侧腹股沟淋巴结活检,以确定其性质. 结果 46例阴茎癌患者中,高分化鳞癌25例,中分化鳞癌18例,低分化鳞癌3例.其中42例行前哨淋巴结活检,20例活检阳性,二期行髂腹股沟淋巴结清扫术;另22例阴性,其中淋巴结炎症及反应性增生者16例,密切观察随访. 结论 对阴茎癌患者手术切除原发病灶,同时作双侧腹股沟前哨淋巴结活检,对确定其有无转移及进一步对活检阳性者行髂腹股沟淋巴结清扫术具有重要的价值.     

亚甲蓝检测阴茎癌前哨淋巴结在腹股沟淋巴结清扫中的意义

目的:探讨亚甲蓝检测阴茎癌前哨淋巴结(SN)在腹股沟淋巴结清扫中的意义。方法:22例阴茎癌患者采取阴茎原发病灶切除同时,采用亚甲蓝检测腹股沟SN作活检,并选择SN转移病例及时行该侧腹股沟区淋巴结清扫术,计算该方法的准确度,假阴性率。结果:95%(21/22)的患者术中可检测到SN,19例患者两侧均可检测到SN,2例为单侧。21例患者中40枚SN,其中阳性淋巴结11例(27.5%)。4例腹股沟SN阴性患者在随访中出现腹股沟淋巴结或盆腔淋巴结转移。亚甲蓝在检查阴茎癌SN阳性预测率100%,准确度81%,其中假阴性率28%。结论:本方法术前准备简单,操作方便,费用较低,可作为一种经济有效的检测方式。     

阴茎癌髂腹股沟淋巴结切除术33例报告

我科 1990年至 2 0 0 1年 10月收治阴茎癌患者 33例 ,对髂腹股沟淋巴切除术在阴茎癌治疗中的作用进行初步探讨。资料与方法　本组 33例。年龄 30～ 83岁 ,平均 5 2岁。ＴＮＭ分期 :Ｔ1Ｎ0 Ｍ0 7例 ,Ｔ1Ｎ1Ｍ0 12例 ,Ｔ2 Ｎ2 Ｍ0 11例 ,Ｔ2 Ｎ2 3 Ｍ13例。Ｊａｋｓｏｎ分期 :Ａ     

T1期乳腺癌前哨淋巴结活检41例报告

目的 探讨前哨淋巴结活检术(sentinel lymph node biopsy，SLNB)在乳腺癌治疗中的应用。方法 使用美蓝染色，对2001年9月至2002年8月连续收治的41例T1期乳腺癌，临床检查腋窝淋巴结阴性的病人行前哨淋巴结活检术。结果 SLNB成功率87．8％(36／41)，假阴性率5．88％(1／17)，准确率97．2％(35／36)。结论 SLNB能够准确预测T1期乳腺癌腋窝淋巴结的转移情况，在缩小手术范围、减少术后并发症的同时，提高了腋窝淋巴结分期的准确性。     

Dynamic Sentinel Lymph Node Biopsy in Patients with Invasive Squamous Cell Carcinoma of the Penis: A Prospective Study of the Long-Term Outcome of 500 Inguinal Basins Assessed at a Single Institution

Background

Dynamic sentinel node biopsy (DSNB) in combination with ultrasound scan (USS) has been the technique of choice at our centre since 2004 for the assessment of nonpalpable inguinal lymph nodes (cN0) in patients with squamous cell carcinoma of the penis (SCCp). Sensitivity and false-negative rates may vary depending on whether results are reported per patient or per node basin, and with or without USS.

Objective

To determine the long-term outcome of patients undergoing DSNB and USS-guided fine-needle aspiration cytology (FNAC) in our cohort of newly diagnosed cN0 SCCp patients, as well as to analyse any variation in sensitivity of the procedure.

Design, setting, and participants

A series of consecutive patients with newly diagnosed SCCp, over a 6-yr period (2004–2010), were analysed prospectively with a minimum follow-up period of 21 mo. All patients had definitive histology of ≥T1G2 and nonpalpable nodes in one or both inguinal basins. Patients with persistent or untreated local disease were excluded from the study.

Intervention

All eligible patients had DSNB and USS with or without FNAC of cN0 groins.

Outcome measurements and statistical analysis

The primary end point was no nodal disease recurrence on follow-up. The secondary end point was complications after DSNB. Sensitivity of the procedure was calculated per node basin, per patient, with DSNB alone, and with USS with DSNB combined.

Results and limitations

Five hundred inguinal basins in 264 patients underwent USS with or without FNAC and DSNB. Seventy-three positive inguinal basins (14.6%) in 59 patients (22.3%) were identified. Four inguinal basins in four patients were confirmed false negative at 5, 8, 12, and 18 mo. Two inguinal basins had positive USS and FNAC and negative DSNB results. Sensitivity of DSNB with USS, with and without FNAC, per inguinal basin was 95% and per patient was 94%. Sensitivity of DSNB alone per inguinal basin and per patient was 92% and 91%, respectively. The DSNB morbidity rate was 7.6%.

Conclusions

DSNB in combination with USS has excellent performance characteristics to stage patients with cN0 SCCp, with a 5% false-negative rate per node basin and a 6% false-negative rate per patient.     

Intramammary sentinel lymph node in patients with breast cancer: Report of four cases

To analyze breast cancer patients with intramammary sentinel lymph node, we reviewed T1-T2N0 breast cancer patients who underwent sentinel lymph node mapping using radioisotope methods. Intramammary sentinel lymph (ISN) nodes were detected in 4 of 166 patients. Three of four ISNs were present in completely different quadrants of the breast from those of primary lesions. Although two patients had no involved nodes, including ISNs, the remaining two with T2 tumor had metastasis of ISNs alone with resulting upstaging. We should keep in mind the presence of intramammary SN in regions apart from the primary tumor, particularly when performing breast conservative surgery.     

腔镜下阴茎癌双侧腹股沟淋巴结清扫术14例报告

目的探讨腔镜下阴茎癌双侧腹股沟淋巴结清扫术的效果。方法2009年9月～2011年11月对14例阴茎癌行腔镜下双侧腹股沟淋巴结清扫术。术前对腹股沟淋巴结和隐静脉进行多普勒超声扫描和盆腔淋巴CT检查,术中建立人工手术腔隙,置人腔镜以及操作器械,先用超声刀扩大皮下腔隙,向上至腹股沟韧带上方的腹外斜肌腱膜,外侧至缝匠肌外缘,内侧为长收肌内侧,下界为股三角顶端,解剖出股动静脉、大隐静脉及其分支,并切除该范围内的淋巴结和脂肪组织,从穿刺孔取出清扫的淋巴结和脂肪组织,术后置引流管引流。结果14例均顺利完成腔镜下腹股沟淋巴清扫术,术中未发生并发症。手术时间平均103min（95～112min）,术中出血量平均85ml（20～130m1）。双侧切除淋巴结共5—14枚,平均9枚,淋巴结均阴性。术后留置引流管平均5d（3～7d）。术后住院5～8d,平均6d。1例出现淋巴囊肿,2个月后消退,其余患者未发生股血管损伤、皮缘坏死、愈合延迟、皮下积液和淋巴漏等切口相关的并发症。14例术后随访6—20个月,平均9个月,患者无明显双下肢肿胀及活动障碍。结论腔镜下阴茎癌双侧腹股沟淋巴结清扫术可以保证清扫范围并减少标准开放手术带来的切口相关并发症。     

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。     

脱套式阴茎固定术治疗隐匿阴茎(附200例报告)

目的：探讨脱套式阴茎固定术对200例隐匿阴茎患儿的治疗效果。方法：对200例隐匿阴茎患儿采用脱套式阴茎固定术,患者平均年龄6．5岁（3～12岁）。其中并发有包茎的患儿160例,明显肥胖者20例。结果：在平均约10个月的随访中,无明显肥胖者术后阴茎外形及发育良好。20例明显肥胖者中有4例术后2～3个月左右出现轻度阴茎回缩,其余阴茎外形良好,无复发。结论：脱套式阴茎固定术是治疗隐匿阴茎的理想术式,术后并发症少,外观满意。     

Radiolocalized Sentinel Lymph Node Biopsy in Squamous Cell Carcinoma of the Oral Cavity and Analysis of Various Parameters

Background Sentinel lymph node (SLN) biopsy seems to be a method that solves the problem of neck management with oral squamous cell carcinoma. Using blue dye methods for detection of neck SLNs from the surface of the operative field seems difficult; therefore, we used radiolocalization alone to detect and extract sentinel nodes. Aside from the various histological and clinical parameters examined in this procedure, we also determined whether they had any clinical significance in relation to the detection of SLNs during the operation. Methods Enrolled subjects had preoperative clinical N0 stage squamous cell carcinoma of the oral cavity and had received an unfiltered ^99mTc sulfur colloid peritumoral injection. Localization of the SLNs was performed by using lymphoscintigraphy and a handheld gamma probe. Results In total, 28 oral squamous cell carcinoma patients were included in this prospective study. Sixty-four SLNs in 27 patients were identified by this method. The identification rate was 96.4%. No false-negative predictions of SLN were noted among any of the patients studied. The numbers of the SLNs found during the operation were larger in patients with positive findings than those with negative findings (P < .05 by the Mann-Whitney U-test). Conclusions SLN radiolocalization provided an acceptable identification rate. The cases of positive findings for metastasis seemed to statistically have more SLNs than did those with negative findings, but more evidence is needed to prove this point. Therefore, SLN biopsies for extracting all possible high-risk nodes may be conducive for oral squamous cell carcinoma surgery.     

阴茎原位癌的诊断及治疗

目的：提高Bowen病及增殖性红斑的诊治水平。方法：分析18例Bowen病及增殖性红斑患者临床病理资料。发病年龄32～72岁，平均49岁。病程3个月～3年，平均1．5年。10例行局部病变切除术或包皮环切术，8例电凝治疗。结果：15例随访4～48个月，2例在阴茎头未治疗区出现新的病变，外涂5％5．氟脲嘧啶软膏治疗治愈后随访3及9个月无复发；13例治愈无复发。结论包括较深层组织的病理活检是鉴别Bowen病或增殖性红斑与阴茎癌以及其他男性外生殖器疾病的关键，局部病变手术切除，5-氟脲嘧啶软膏外涂可有效治疗Bowen病或增殖性红斑。