会阴部Paget病广泛切除术后并发急性肾损伤1例报告并文献复习

发布时间：2018-03-26 03:03

本文选题：乳房外Paget病　切入点：皮肤恶性肿瘤　出处：《南京大学》2014年硕士论文

【摘要】：目的：回顾乳房外Paget病及急性肾损伤的的诊断和治疗。方法：回顾性分析一例会阴部Paget病扩大切除术后并发急性肾损伤患者的病例资料,并结合文献复习。设计：病例报告。病例：患者64岁男性,因“发现会阴皮肤新生物反复破溃15年余”入院。入院查体见右腹股沟区、阴茎、右侧阴囊及会阴部可见一面积约9cmX 8cm大小湿疹样红色斑块,略高出周围正常皮肤,色泽不均,界限较清楚,皮损内可见散在破溃创面,伴少量淡黄色渗液,部分覆盖有黄色痂皮,双侧腹股沟淋巴结未触及肿大。排除手术禁忌后,行病灶广泛切除+植皮术。患者术后三天出现无尿、腹胀。生化全套提示尿素氮及肌酐持续升高。创面随后也出现严重感染。干预：给予血液透析治疗,同时给予抗感染、利尿、纠正贫血及低蛋白血症、营养支持等支持治疗。创面每日积极换药,给予红光治疗,控制感染。结果：患者尿量逐渐恢复正常,生化全套提示尿素氮及肌酐降至正常。术区移植皮片大部分成活,创面Ⅲ/乙级愈合。结论：乳房外Paget病是一种特殊的皮肤恶性肿瘤,大汗腺分布区域多发,且易伴发内脏肿瘤。临床表现缺乏特异性,容易被误诊为皮肤病。诊断的金标准是组织病理检查。乳房外Paget病首选手术治疗。老年人在围手术期需加强液体管理,监测血压、肾功能、尿量等情况,慎用肾损毒性药物,预防心、脑、肾等重要脏器的并发症。急性肾损伤是围手术期的严重并发症,其治疗关键在于原发病及致病因素的治疗,早期肾脏替代治疗与有效的支持治疗也是急性肾损伤患者重要治疗措施。
[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.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R739.5

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