保留龜頭的腫瘤切除術(shù)對(duì)T1期陰莖癌患者療效及性功能的影響

袁也晴 張軼庠 汪青蓉 張學(xué)齊

摘要：目的? 分析T1期陰莖癌行保留龜頭的腫瘤切除術(shù)加腹腔鏡腹股溝淋巴結(jié)清掃術(shù)對(duì)患者療效及性功能的影響。方法? 回顧性分析我院及中山大學(xué)附屬腫瘤醫(yī)院自2014年1月～2018年6月收治的8例行保留龜頭的陰莖腫瘤切除術(shù)（保留龜頭組）與10例行陰莖部分切除術(shù)（部分切除組）的T1期陰莖癌患者臨床資料，術(shù)后隨訪(fǎng)了解其局部及遠(yuǎn)處復(fù)發(fā)情況，采用國(guó)際勃起功能指數(shù)問(wèn)卷（ⅡEF-5）、性滿(mǎn)意指數(shù)（ISS）問(wèn)卷分別在術(shù)后6個(gè)月評(píng)估患者的勃起功能和性滿(mǎn)意度，對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果隨訪(fǎng)6月～5年，1例保留龜頭患者出現(xiàn)原發(fā)腫瘤復(fù)發(fā)，其余患者均未見(jiàn)腫瘤復(fù)發(fā)及轉(zhuǎn)移。術(shù)后6個(gè)月，保留龜頭組的患者ⅡEF-5評(píng)分為（24.48±1.89）分，與術(shù)前的（24.53±2.41）分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），但高于陰莖部分切除組患者的（21.59±3.26）分，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;保留龜頭組的ISS評(píng)分為（36.38±16.11）分，與術(shù)前的（38.27±14.38）分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），但低于陰莖部分切除組患者的（57.63±15.63）分，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論? 對(duì)于T1期的陰莖癌患者，保留龜頭的手術(shù)加上腹腔鏡腹股溝淋巴結(jié)清掃術(shù)安全有效，并可使患者維持更好的性功能和滿(mǎn)意度。

關(guān)鍵詞：陰莖癌;保留龜頭;腹股溝淋巴結(jié)清掃;性功能

中圖分類(lèi)號(hào)：R737.27? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻(xiàn)標(biāo)識(shí)碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2019.10.032

文章編號(hào)：1006-1959（2019）10-0102-04

Abstract：Objective To analyze the effect of tumor resection and laparoscopic inguinal lymphadenectomy on the efficacy and sexual function of patients with T1 stage penile cancer.Methods? A retrospective analysis of 8 cases of penile tumor resection （preserving glans group） and 10 cases of partial penectomy （partial resection group） were performed in our hospital and Sun Yat-sen University Cancer Hospital from January 2014 to June 2018. The clinical data of patients with stage T1 penile cancer were followed up for local and distant recurrence. The international erectile function index questionnaire （IIEF-5） and sexual satisfaction index （ISS） questionnaire were used to evaluate patients at 6 months after operation. The erectile function and sexual satisfaction were statistically analyzed.Results? During the follow-up period of 6 months to 5 years， 1 patient with glans retained primary tumor recurrence， and no tumor recurrence and metastasis were found in other patients.At 6 months after surgery， the IIEF-5 score of the patients who retained the glans group was （24.48±1.89） points. Compared with the preoperative （24.53±2.41） points， the difference was not statistically significant （P>0.05）， but higher than the penis.The patients in the partial resection group （21.59±3.26） scores were statistically significant （P<0.05）. The ISS scores of the preserved glans group were（36.38±16.11） points， compared with the preoperative（38.27±14.38） points，the difference was not statistically significant （P>0.05）， but was lower than that in the penile partial resection group （57.63±15.63）， the difference was statistically significant （P<0.05）.Conclusion? For patients with stage T1 penile cancer， surgery to preserve the glans plus laparoscopic inguinal lymph node dissection is safe and effective， and allows patients to maintain better sexual function and satisfaction.