病灶切除联合皮瓣移植治疗复发性外阴Paget病一例

doi:10.12280/gjfckx.20241114

摘要/Abstract

摘要：

外阴Paget病（vulvar Paget′s disease，VPD）是一种极为罕见的外阴恶性肿瘤，以手术治疗为主，虽死亡率低，但局部复发率高，治疗复发性VPD具有一定的挑战性。报告1例74岁复发性VPD的病例资料，患者VPD术后7年因外阴瘙痒伴渗液3个月就诊，妇科检查发现两侧大阴唇皮肤质硬，色素沉着、脱失相间，左侧大阴唇上部可见一病灶，5 cm×4 cm大小，质硬，局部色红，表面破溃、结痂，病理活检示符合VPD，经病灶切除联合皮瓣移植手术治疗，术后予咪喹莫特乳膏外用治疗，现术后近5年，患者病情稳定，生活质量可，提示对于多次复发性VPD采取病灶切除联合皮瓣移植术可取得满意疗效。

关键词: 佩吉特病，乳腺外, 复发, 外科皮瓣, 皮肤移植, 修复外科手术

Abstract:

Vulvar Paget′s disease (VPD) is an extremely rare vulvar malignant tumor, mainly surgically treated. Although the mortality rate is low, the local recurrence rate is high. It is challenging to treat recurrent VPD. This article report the case data of a 74-year-old recurrent VPD. The patient visited the hospital due to vulva itching and oozing for 3 months after 7 years after VPD surgery. Gynecological examination revealed that the skin of the labia majora on both sides was hard, pigmentation and loss of pigmentation. A lesion can be seen in the upper part of the labia majora on the left vulva, 5 cm × 4 cm in size, hard, local red, surface rupture and scab, pathological biopsy showed that it meets VPD. Then the surgery of lesion resection combined with skin flap transplantation was performed. Imiquimod cream was treated with topical treatment. Now, nearly 5 years after the operation, the patient′s condition is stable and her quality of life is good. This case suggests that the efficacy of lesion resection combined with skin flap transplantation for multiple recurrent VPD is satisfactory.

Key words: Paget disease, extramammary, Recurrence, Surgical flaps, Skin transplantation, Reconstructive surgical procedures

陈秀杰, 王雅楠, 程倩倩, 张继雯, 宋殿荣. 病灶切除联合皮瓣移植治疗复发性外阴Paget病一例[J]. 国际妇产科学杂志, 2025, 52(2): 237-240.

CHEN Xiu-jie, WANG Ya-nan, CHENG Qian-qian, ZHANG Ji-wen, SONG Dian-rong. Lesion Resection Combined with Skin Flap Transplantation in the Treatment of Recurrent Vulvar Paget′s Disease: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2025, 52(2): 237-240.

图/表 4

图1 VPD活检组织病理图（HE染色×200）注：鳞状上皮增生伴角化不全，内见弥漫生长的圆形或卵圆形上皮样细胞，胞质透明，核大深染，中-重度异型，核分裂象可见。标尺=100 μm。

图2 术中病灶切除范围标记图

图3 外阴病灶皮瓣设计及移植图注：A 右侧皮瓣设计；B 右侧皮瓣移植；C 左侧皮瓣设计；D 左侧皮瓣移植。

图4 术后2年随访外阴外观图

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