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目的探讨艾滋病患者合并阴茎癌的临床诊断与治疗。方法收集作者2012年3月至2015年2月援助博茨瓦纳期间所诊治的艾滋病合并阴茎癌患者共24例,对其临床表现、诊断、手术治疗方案、术后疗效等影响因素进行分析总结。结果 24例患者平均年龄38.6岁。临床表现为局部肿块(11/24,45.8%)、溃疡(9/24,37.5%)及丘疹(4/24,16.7%)。发病时22例患者正接受HAART治疗,18例(75.0%)患者CD4水平较低(低于350/μL),存在明显的免疫抑制状态。病理类型为鳞状细胞癌22例,鳞癌合并卡波西肉瘤2例。22例患者进行手术治疗,2例T4期患者未手术治疗。2例阴茎鳞癌合并卡波西肉瘤,于发病后4个月和6个月得到确诊,并行阴茎全切加尿道会阴部造口术,术后恢复良好,未见肿瘤转移。结论卡波西肉瘤是艾滋病患者常见的皮肤病损,阴茎卡波西肉瘤容易掩盖阴茎鳞状细胞癌的症状,从而耽误阴茎癌诊断与治疗,需要引起足够的注意。
Objective To explore the clinical diagnosis and treatment of AIDS patients with penile cancer. Methods A total of 24 AIDS patients with penile cancer who were diagnosed and treated during the period from March 2012 to February 2015 in Botswana were collected and analyzed for their clinical manifestations, diagnosis, surgical treatment and postoperative effects. Results The average age of 24 patients was 38.6 years. Clinical manifestations of local mass (11 / 24,45.8%), ulcers (9/24, 37.5%) and papules (4 / 24,16.7%). At onset, 22 patients were receiving HAART, and 18 (75.0%) patients had lower CD4 levels (below 350 / μL) and a clear immunosuppressive state. Pathological type squamous cell carcinoma in 22 cases, squamous cell carcinoma with Kaposi’s sarcoma in 2 cases. Twenty-two patients underwent surgery, and two patients with T4 had no surgery. Two cases of squamous cell carcinoma of the penis with Kaposi’s sarcoma were diagnosed at 4 months and 6 months after the onset of the disease. All patients underwent penile resection plus urethral perineal ostomy. No postoperative tumor recovery was found. Conclusion Kaposi’s sarcoma is a common skin lesions in AIDS patients, penile Kaposi’s sarcoma easily mask the symptoms of penile squamous cell carcinoma, which delays the diagnosis and treatment of penile cancer, need to attract enough attention.