保留龟头的肿瘤切除术对T1期阴茎癌患者疗效及性功能的影响

袁也晴 张轶庠 汪青蓉 张学齐

摘要：目的  分析T1期陰茎癌行保留龟头的肿瘤切除术加腹腔镜腹股沟淋巴结清扫术对患者疗效及性功能的影响。方法  回顾性分析我院及中山大学附属肿瘤医院自2014年1月～2018年6月收治的8例行保留龟头的阴茎肿瘤切除术（保留龟头组）与10例行阴茎部分切除术（部分切除组）的T1期阴茎癌患者临床资料，术后随访了解其局部及远处复发情况，采用国际勃起功能指数问卷（ⅡEF-5）、性满意指数（ISS）问卷分别在术后6个月评估患者的勃起功能和性满意度，对数据进行统计学分析。结果随访6月～5年，1例保留龟头患者出现原发肿瘤复发，其余患者均未见肿瘤复发及转移。术后6个月，保留龟头组的患者ⅡEF-5评分为（24.48±1.89）分，与术前的（24.53±2.41）分比较，差异无统计学意义（P>0.05），但高于阴茎部分切除组患者的（21.59±3.26）分，差异有统计学意义（P<0.05）;保留龟头组的ISS评分为（36.38±16.11）分，与术前的（38.27±14.38）分比较，差异无统计学意义（P>0.05），但低于阴茎部分切除组患者的（57.63±15.63）分，差异有统计学意义（P<0.05）。结论  对于T1期的阴茎癌患者，保留龟头的手术加上腹腔镜腹股沟淋巴结清扫术安全有效，并可使患者维持更好的性功能和满意度。

关键词：阴茎癌;保留龟头;腹股沟淋巴结清扫;性功能

中图分类号：R737.27                                 文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2019.10.032

文章编号：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.