本文選題：乳房外Paget病　切入點(diǎn)：皮膚惡性腫瘤　出處：《南京大學(xué)》2014年碩士論文

【摘要】：目的：回顧乳房外Paget病及急性腎損傷的的診斷和治療。方法：回顧性分析一例會(huì)陰部Paget病擴(kuò)大切除術(shù)后并發(fā)急性腎損傷患者的病例資料,并結(jié)合文獻(xiàn)復(fù)習(xí)。設(shè)計(jì)：病例報(bào)告。病例：患者64歲男性,因“發(fā)現(xiàn)會(huì)陰皮膚新生物反復(fù)破潰15年余”入院。入院查體見右腹股溝區(qū)、陰莖、右側(cè)陰囊及會(huì)陰部可見一面積約9cmX 8cm大小濕疹樣紅色斑塊,略高出周圍正常皮膚,色澤不均,界限較清楚,皮損內(nèi)可見散在破潰創(chuàng)面,伴少量淡黃色滲液,部分覆蓋有黃色痂皮,雙側(cè)腹股溝淋巴結(jié)未觸及腫大。排除手術(shù)禁忌后,行病灶廣泛切除+植皮術(shù)�；颊咝g(shù)后三天出現(xiàn)無(wú)尿、腹脹。生化全套提示尿素氮及肌酐持續(xù)升高。創(chuàng)面隨后也出現(xiàn)嚴(yán)重感染。干預(yù)：給予血液透析治療,同時(shí)給予抗感染、利尿、糾正貧血及低蛋白血癥、營(yíng)養(yǎng)支持等支持治療。創(chuàng)面每日積極換藥,給予紅光治療,控制感染。結(jié)果：患者尿量逐漸恢復(fù)正常,生化全套提示尿素氮及肌酐降至正常。術(shù)區(qū)移植皮片大部分成活,創(chuàng)面Ⅲ/乙級(jí)愈合。結(jié)論：乳房外Paget病是一種特殊的皮膚惡性腫瘤,大汗腺分布區(qū)域多發(fā),且易伴發(fā)內(nèi)臟腫瘤。臨床表現(xiàn)缺乏特異性,容易被誤診為皮膚病。診斷的金標(biāo)準(zhǔn)是組織病理檢查。乳房外Paget病首選手術(shù)治療。老年人在圍手術(shù)期需加強(qiáng)液體管理,監(jiān)測(cè)血壓、腎功能、尿量等情況,慎用腎損毒性藥物,預(yù)防心、腦、腎等重要臟器的并發(fā)癥。急性腎損傷是圍手術(shù)期的嚴(yán)重并發(fā)癥,其治療關(guān)鍵在于原發(fā)病及致病因素的治療,早期腎臟替代治療與有效的支持治療也是急性腎損傷患者重要治療措施。
[Abstract]:Objective: to review the diagnosis and treatment of extramammary Paget's disease and acute renal injury. And combined with literature review. Design: case report. Case: a 64-year-old male was admitted to hospital because of "recurrent rupture of the perineal skin for more than 15 years". The admission examination showed the right inguinal area, penis, and penile. In the right scrotum and perineum, an area of about 9cmX 8cm size eczema red plaque was seen, slightly higher than the surrounding normal skin, the color was uneven, the boundary was clear, the lesions could be seen scattered in the broken wound, with a small amount of yellowish exudate. Partially covered with yellow callus, bilateral inguinal lymph nodes did not touch swelling. After removal of operative taboos, extensive excision of lesions and skin grafting were performed. Abdominal distention. Biochemical complete set indicates continuous increase in urea nitrogen and creatinine. Severe infection also occurs on the wound. Intervention: hemodialysis therapy, antiinfection, diuresis, correction of anemia and hypoproteinemia, Nutrition support and other supportive treatment. Wounds were actively changed daily, treated with red light to control infection. Results: the urine volume of the patients gradually returned to normal, and the biochemical complete set indicated that urea nitrogen and creatinine decreased to normal. Most of the skin grafts survived in the area of operation. Conclusion: Extramammary Paget's disease is a kind of special skin malignant tumor, with multiple hypersweat glands, and is easy to be accompanied by visceral tumor. It is easy to be misdiagnosed as dermatosis. The gold standard of diagnosis is histopathology. The first choice of surgical treatment for extramammary Paget disease. The elderly need to strengthen fluid management, monitor blood pressure, renal function, urine volume and so on during perioperative period. Prevention of complications of heart, brain, kidney and other important organs. Acute renal injury is a serious complication in perioperative period. The treatment of acute renal injury lies in the treatment of primary disease and pathogenic factors. Early renal replacement therapy and effective supportive therapy are also important for acute renal injury patients.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.5;R739.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳萬(wàn)青;張思維;曾紅梅;鄭榮壽;鄒小農(nóng);趙平;吳良有;李光琳;赫捷;;中國(guó)2010年惡性腫瘤發(fā)病與死亡[J];中國(guó)腫瘤;2014年01期

2 頡玉勝;宋維旭;魏翠萍;劉卉;楊海靜;;乳房外Paget病8例臨床分析[J];中華實(shí)用診斷與治療雜志;2013年09期

3 張良;;Mohs顯微描記手術(shù)治療皮膚惡性腫瘤56例臨床分析[J];中國(guó)皮膚性病學(xué)雜志;2012年03期

4 胡紅華;程浩;;乳房外Paget病19例臨床與隨訪分析[J];中國(guó)皮膚性病學(xué)雜志;2011年08期

5 席晨輝;莊大勇;鄭魯明;周鵬;段松建;柳曉建;賀青卿;;術(shù)中冰凍切片聯(lián)合快速免疫組織化學(xué)染色檢測(cè)乳腺癌前哨淋巴結(jié)微轉(zhuǎn)移的臨床研究[J];中華乳腺病雜志(電子版);2011年04期

6 李黎波;羅榮城;張?zhí)m英;羅宇玲;繆景霞;;光動(dòng)力療法治療乳房外Paget病臨床研究[J];中華皮膚科雜志;2009年12期

7 張寧;龔侃;楊勇;那彥群;;陰囊Paget病的治療和預(yù)后(附23例報(bào)告)[J];中華男科學(xué)雜志;2006年12期

8 陸麗萍,朱菁;激光光敏診斷在腫瘤診斷中的應(yīng)用[J];應(yīng)用激光;2005年05期

9 陳曉棟,方方,趙亮,吳信峰,王強(qiáng),王焱;乳房外Paget病27例臨床分析[J];中華皮膚科雜志;2001年06期

10 許良中，，邱丙森，孔今誠(chéng)，胡筱娟，張?zhí)┟�，朱偉萍，金愛�?c－erbB－2與P53在乳腺與乳腺外Paget病中的表達(dá)[J];上海醫(yī)科大學(xué)學(xué)報(bào);1994年02期

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