Mohs手术联合光动力治疗乳房外Paget病的临床观察(1)
[摘要]目的：观察Mohs手术联合光动力治疗乳房外Paget病的临床疗效。方法：8例确诊为乳房外Paget病患者纳入治疗观察，术前皮疹部位用ALA封包，Wood灯下标记手术边界，运用Mohs手术切除病灶，伤口拆线后每隔10d光动力治疗1次，总计治疗4次，随访半年观察其疗效。结果：纳入治疗的患者伤口均甲级愈合，未出现感染等并发症，随访半年无复发，外阴部形态结构功能无明显影响，患者就医满意度高。结论：Mohs手术联合光动力治疗外阴部位乳房外Paget病效果较好，病灶切除干净，患者术后恢复快，肿瘤复发率低，可作为外阴部乳房外Paget病的首选治疗方案。
[关键词]Mohs手术；光动力；乳房外Paget病；临床疗效；Wood灯
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0004-03
Abstract： Objective To assess the effect of Mohs surgery combined with photodynamic therapy in the treatment of extramammary Paget's disease. Methods A total of 8 cases of diagnosed with extramammary Paget's disease were under observation. ALA solution was applied to the affected area before the operation， Wood’s lamp was used to determine the margin of the lesion. Mohs surgery was used to excise the lesions. The photodynamic therapy was performed once every 10 days after stitch removal， a total of 4 treatments were performed and followed up for six months. Results There were no complications postoperatively， such as surgical site infection， deformation of the vulva and delayed healing of incision， all the patients were advised regular follow-up and no recurrence of the tumor until the last follow-up done six months after the surgery， all the patients were satisfied with the effect of the treatment. Conclusion Mohs surgery combined with photodynamic therapy is effective for treating of extramammary Paget's disease in the vulva region. The lesions are removed cleanly and the patients recover quickly after operation with low rate of tumor recurrence. This can be used as the first choice for treatment of extramammary Paget's disease in the vulva.
, http://www.100md.com
Key words： Mohs surgery； photodynamic therapy； extramammary Paget's disease； clinical curative effect； Wood’s lamp
乳房外Paget病(Extramammary Paget's disease，EMPD)又称乳房外湿疹样癌，多发生于大汗腺分布丰富的区域，如腋窝、腹股沟、阴囊等部位，是一种少见的皮肤恶性肿瘤，临床上常表现为界限清或不清楚的红斑，可伴有糜爛、渗出，边缘可呈淡褐色，表面可结痂伴鳞屑，患者常有瘙痒、疼痛或烧灼感等不适，部分可伴发相应部位的其他恶性肿瘤[1]。其临床表现与慢性湿疹或皮炎相似，容易误诊，治疗不当可致病程迁延或疾病扩散，即使诊断正确，常规治疗后也极易复发[2]。本研究应用Mohs手术联合光动力(Photodynamic therapy， PDT)疗法治疗8例外阴部EMPD患者，取得满意效果，现报道如下。
1 资料和方法
, http://www.100md.com
1.1 一般资料：共纳入笔者医院2014年1月-2017年9月收治的EMPD患者8例，男性5例，女性3例，年龄44～72岁，平均年龄(61.5±8.88)岁，患者皮疹均位于外阴部位，术前局部活检和术后组织病理检查确诊为EMPD，所有患者均签署知情同意书，常规术前检查提示无明显手术禁忌证。
1.2 手术方法
1.2.1 术前设计：术前1d备皮，用高锰酸钾溶液清洗外阴部位，术前取5-氨基酮戊酸118mg(商品名：艾拉/ALA，上海复旦张江生物医药股份有限公司，118mg/支)，加入0.5ml注射用水，配制成浓度为20%的ALA溶液，用无菌纱布浸润溶液后湿敷皮损及其周围2cm区域，保鲜膜覆盖封包3h后取下，局部清洗后在Wood灯下确定肿瘤的边界，用亚甲蓝沿肿瘤边缘标记切口，术前1h内预防性使用抗菌药物1次。
1.2.2 术中操作：常规消毒铺巾，2%利多卡因10ml+生理盐水100ml进行局部浸润麻醉，麻醉成功后沿标记线切开皮肤及皮下组织，深度达脂肪层及肉膜层，边切除边止血，结扎血管，完整切除病变组织并分成若干块，切缘染色，切下组织和患者外阴部相应位置标记相同的记号，并画出缺损形状参考图，每块组织均快速送冰冻切片，检查切口侧缘和底部是否有肿瘤细胞残留，根据术中冰冻切片结果选择是否继续扩大切除和切除的部位及深度，重复这一过程直至肿瘤切尽为止，缺损创面采用皮瓣或者植皮方案修复。, http://www.100md.com(叶文正 李词娟 吴一文)
[关键词]Mohs手术；光动力；乳房外Paget病；临床疗效；Wood灯
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0004-03
Abstract： Objective To assess the effect of Mohs surgery combined with photodynamic therapy in the treatment of extramammary Paget's disease. Methods A total of 8 cases of diagnosed with extramammary Paget's disease were under observation. ALA solution was applied to the affected area before the operation， Wood’s lamp was used to determine the margin of the lesion. Mohs surgery was used to excise the lesions. The photodynamic therapy was performed once every 10 days after stitch removal， a total of 4 treatments were performed and followed up for six months. Results There were no complications postoperatively， such as surgical site infection， deformation of the vulva and delayed healing of incision， all the patients were advised regular follow-up and no recurrence of the tumor until the last follow-up done six months after the surgery， all the patients were satisfied with the effect of the treatment. Conclusion Mohs surgery combined with photodynamic therapy is effective for treating of extramammary Paget's disease in the vulva region. The lesions are removed cleanly and the patients recover quickly after operation with low rate of tumor recurrence. This can be used as the first choice for treatment of extramammary Paget's disease in the vulva.
, http://www.100md.com
Key words： Mohs surgery； photodynamic therapy； extramammary Paget's disease； clinical curative effect； Wood’s lamp
乳房外Paget病(Extramammary Paget's disease，EMPD)又称乳房外湿疹样癌，多发生于大汗腺分布丰富的区域，如腋窝、腹股沟、阴囊等部位，是一种少见的皮肤恶性肿瘤，临床上常表现为界限清或不清楚的红斑，可伴有糜爛、渗出，边缘可呈淡褐色，表面可结痂伴鳞屑，患者常有瘙痒、疼痛或烧灼感等不适，部分可伴发相应部位的其他恶性肿瘤[1]。其临床表现与慢性湿疹或皮炎相似，容易误诊，治疗不当可致病程迁延或疾病扩散，即使诊断正确，常规治疗后也极易复发[2]。本研究应用Mohs手术联合光动力(Photodynamic therapy， PDT)疗法治疗8例外阴部EMPD患者，取得满意效果，现报道如下。
1 资料和方法
, http://www.100md.com
1.1 一般资料：共纳入笔者医院2014年1月-2017年9月收治的EMPD患者8例，男性5例，女性3例，年龄44～72岁，平均年龄(61.5±8.88)岁，患者皮疹均位于外阴部位，术前局部活检和术后组织病理检查确诊为EMPD，所有患者均签署知情同意书，常规术前检查提示无明显手术禁忌证。
1.2 手术方法
1.2.1 术前设计：术前1d备皮，用高锰酸钾溶液清洗外阴部位，术前取5-氨基酮戊酸118mg(商品名：艾拉/ALA，上海复旦张江生物医药股份有限公司，118mg/支)，加入0.5ml注射用水，配制成浓度为20%的ALA溶液，用无菌纱布浸润溶液后湿敷皮损及其周围2cm区域，保鲜膜覆盖封包3h后取下，局部清洗后在Wood灯下确定肿瘤的边界，用亚甲蓝沿肿瘤边缘标记切口，术前1h内预防性使用抗菌药物1次。
1.2.2 术中操作：常规消毒铺巾，2%利多卡因10ml+生理盐水100ml进行局部浸润麻醉，麻醉成功后沿标记线切开皮肤及皮下组织，深度达脂肪层及肉膜层，边切除边止血，结扎血管，完整切除病变组织并分成若干块，切缘染色，切下组织和患者外阴部相应位置标记相同的记号，并画出缺损形状参考图，每块组织均快速送冰冻切片，检查切口侧缘和底部是否有肿瘤细胞残留，根据术中冰冻切片结果选择是否继续扩大切除和切除的部位及深度，重复这一过程直至肿瘤切尽为止，缺损创面采用皮瓣或者植皮方案修复。, http://www.100md.com(叶文正 李词娟 吴一文)