黄骥 熊剑勇 涂新华 郝超

[摘要] 目的 研究早期阴茎癌患者选择保留阴茎的手术方式及治疗效果。 方法 8例早期阴茎癌患者术前常规检查未发现淋巴结转移及远处转移，术前行病理活检或术中冰冻病理检查明确阴茎鳞癌，行手术切除肿瘤病灶，保留阴茎的解剖完整性及功能完整性。 结果 随访2～5年，8例均成活，其中无复发5例，复发后补充手术2例，出现腹股沟淋巴结转移1例。 结论 早期阴茎癌行保留阴茎的手术效果良好，但需要严格把握入组标准及掌握相应手术技巧。

[关键词] 早期阴茎癌；阴茎保留手术；性功能；预后

[中图分类号] R737.27 [文献标识码] B [文章编号] 1673-9701（2018）02-0080-02

[Abstract] Objective To study the surgical methods and therapeutic effect of selection of retaining penis in the patients with early penile cancer. Methods There were no lymph node metastasis and distant metastasis in 8 patients with early penile cancer in the preoperative routine examination. Preoperative pathological biopsy or intraoperative frozen pathological examination confirmed penile squamous cell carcinoma. Surgical removal of tumor lesions was carried out， and the penile anatomical integrity and functional integrity were retained. Results After 2 to 5 years of follow-up， 8 patients survived. Among them， 6 cases had no recurrence， 1 case had recurrence and was given supplementary surgery， and 1 case had inguinal lymph node metastasis. Conclusion The surgical effect for retaining penis in the early penile cancer is favorable， but the enrollment standard should be strictly controlled and the corresponding surgical techniques should be mastered.

[Key words] Early penile cancer； Penile retaining surgery； Sexual function； Prognosis

陰茎癌是一种显著与经济增长负相关的泌尿生殖系统恶性肿瘤，随着我国经济状况的发展和人们卫生水平的提高，其发病率明显降低[1]。以上海市为例，1982 年为1.09/10 万男性，1988 年降低至0.34/10 万男性[2]。阴茎部分切除及根治性阴茎全切除是治疗阴茎癌的两种常用有效手术方式，其治疗效果肯定，却导致阴茎完整性的破坏及性生活的缺失，同时因术后需改变排尿方式而造成心理上的阴影。特别对于中青年男性患者，术后不乏出现严重心理疾病甚至放弃生命的极端事例[3]。

保留阴茎的肿瘤切除术（penile-sparing surgery， PSS）能在切除肿瘤的同时，保留阴茎的正常结构及生理功能，也保留了男性患者的心理尊严[4-5]，但治疗效果并未达成统一共识，部分学者认为其存在局部复发的风险。本文对近年来我院收治的12例因强烈要求保留阴茎的早期阴茎癌患者行PSS术后进行追踪随访，评估PSS术后的治疗效果及患者心理健康状况。……