Paget's病
Conservative Management of Paget Disease of the Breast with Radiotherapy
10-and15-Year Results
Jennifer K.Marshall,M.R.C.P.1
Kent A.Grif?th,M.S.2
Bruce G.Haffty,M.D.3
Lawrence J.Solin,M.D.4
Frank A.Vicini,M.D.5
Beryl McCormick,M.D.6
David E.Wazer,M.D.7
Abram Recht,M.D.8
Lori J.Pierce,M.D.1
1Department of Radiation Oncology,University of Michigan School of Medicine,Ann Arbor,Michigan.
2Biostatistics Core,University of Michigan Cancer Center,Ann Arbor,Michigan.
3Department of Therapeutic Radiology,Yale Uni-versity School of Medicine,New Haven,Connect-icut.
4Department of Radiation Oncology,University of Pennsylvania Hospital,Philadelphia,Pennsylvania.
5Department of Radiation Oncology,William Beaumont Hospital,Royal Oak,Michigan.
6Department of Radiation Oncology,Memorial Hospital,Memorial Sloan-Kettering Cancer Center, New York,New York.
7Department of Radiation Oncology,Tufts New England Medical Center,Boston,Massachusetts.
8Department of Radiation Oncology,Beth Israel Deaconess Medical Center,and Harvard Medical School,Boston,Massachusetts.
Presented at the44th Annual Meeting of the Amer-ican Society of Therapeutic Radiology and Oncol-ogy,New Orleans,Louisiana,October6–10,2002. Address for reprints:Lori J.Pierce,M.D.,Depart-ment of Radiation Oncology,University of Michigan School of Medicine,Cancer and Geriatrics Center, 1500E.Medical Center Drive,Room4308,Ann Arbor,MI48109;Fax:(734)647-9654;E-mail: ljpierce@https://www.wendangku.net/doc/c010726935.html,
Received October23,2002;revision received De-cember30,2002;accepted January9,2002.BACKGROUND.At5-year follow-up,patients with Paget disease of the breast who were treated with breast-conserving surgery(BCS)and radiotherapy(RT)had excellent results.The current report provides10-and15-year rates of tumor control in the breast,as well as disease-free and overall survival rates following BCS and RT in a cohort of patients with Paget disease presenting without a palpable mass or mammographic density.
METHODS.Through a collaborative review of patients treated with BCS and RT from seven institutions,38cases of Paget disease of the breast presenting without a palpable mass or mammographic density were identi?ed.All patients had pathologic con?rmation of typical Paget cells at time of diagnosis.Thirty-six of38patients had a minimum follow-up greater than12months and constitute the study cohort.Ninety-four percent of patients underwent com-plete or partial excision of the nipple-areola complex and all patients received a median external beam irradiation dose of50Gy(range,45–54Gy)to the whole breast.Ninety-seven percent of patients also received a boost to the remaining nipple or tumor bed,a median total dose of61.5Gy(range, 50.4–70Gy).
RESULTS.With median follow-up of113months(range,18–257months),4of36 patients(11%)developed a?rst recurrence of disease in the treated breast only. Two of the four recurrences in the breast were ductal carcinoma in situ(DCIS) only and two were invasive with DCIS.Two additional patients had a recurrence in the breast as a component of?rst failure.Actuarial local control rates for the breast as the only site of?rst recurrence were91%at5years(95%con?dence interval[CI],80–100%)and87%(95%CI,75–99%)at both10and15years. Actuarial local control rates for breast recurrence,as a component of?rst failure,were91%(95%CI,80–100%),83%(95%CI,69–97%),and76%(95%CI, 58–94%)at5,10,and15years,respectively.No clinical factors were identi?ed as signi?cant predictors for breast recurrence.Five-,10-and15-year actuarial rates for survival without disease of97%(95%CI,90–100%)and5-,10-,and 15-year actuarial rates of overall survival of93%(95%CI,84–100%)at5years and90%(95%CI,78–100%)at10and15years were reported. CONCLUSIONS.These data con?rm excellent rates of local control,disease-free survial,and overall survival at10and15years following BCS and RT for Paget disease of the breast.This study continues to support the recommendation of local excision and de?nitive breast irradiation as an alternative to mastectomy in the treatment of patients with Paget disease presenting without a palpable mass or mammographic density.Cancer2003;97:2142–9.
?2003American Cancer Society.
DOI10.1002/cncr.11337
KEYWORDS:Paget disease,breast carcinoma,radiotherapy,breast conservation.
2142
?2003American Cancer Society
P aget disease of the breast represents1–3%of all breast malignancies1–5and is characterized patho-logically by the presence of round intraepidermal cells of the nipple.Although the majority of cases of Paget disease will have an underlying breast malignancy,1–4 previous studies of patients treated with mastectomy have identi?ed two distinct clinical presentations with associated histologic?ndings.1,5Approximately90% of patients presenting with a palpable or mammo-graphic mass will have an underlying invasive carci-noma.Conversely,66–86%of patients without a clin-ical mass on physical examination or mammogram will have ductal carcinoma in situ(DCIS)alone.1,5 Prognosis is determined primarily by the presence or absence of an invasive component,1,2,5and recom-mendations for systemic therapy have been suggested accordingly.
The role of breast-conserving surgery(BCS)with radiotherapy(RT)for selected patients with Paget dis-ease,however,has not been de?ned fully.Multiple randomized trials have found BCS and RT to be an acceptable alternative and often preferable option to mastectomy for patients with early-stage invasive breast carcinoma.Randomized trials also have con-?rmed the highly successful results of BCS and RT in the treatment of patients with DCIS.6–8However,due to the rarity of Paget disease of the breast,a prospec-tive,randomized trial comparing BCS and RT to mas-tectomy is unlikely to be feasible.Therefore,several retrospective studies have reviewed limited experi-ence with RT alone or conservative surgery with or without the addition of RT in the treatment of Paget disease,but the analyses are limited by small patient numbers with limited follow-up and/or variation in clinical presentation.2,9–13The current report presents an analysis of a collaborative series from seven insti-tutions comprising patients with Paget disease of the breast presenting with nipple changes in the absence of a palpable mass or mammographic density who were treated with BCS and RT.Rates of local control and disease-free and overall survival at5years were reported previously.14We report the results with ex-tended follow-up at10and15years.
MATERIALS AND METHODS
All patients diagnosed with Paget disease of the breast without a palpable mass or mammographic density and treated with BCS and RT between1980and2000 at7collaborating institutions were identi?ed.Patients were treated with breast conservation based on pa-tient preference.No patients were referred for RT due to contraindications to surgery.Previously reported cases were updated by the originating institutions with respect to date of last follow-up,survival status, patterns of failure and complications,as appropriate. All new cases identi?ed since the previous analysis and treated with BCS and RT were added to the data-set and included in the current analysis.Thirty-eight cases of Paget disease of the breast were identi?ed from the following institutions:10from the University of Michigan,9from Yale University,5each from the University of Pennsylvania and William Beaumont Hospital,4from Memorial Sloan-Kettering Cancer Center,3from Tufts University,and2cases from Beth Israel Deaconess Medical Center.Due to follow-up limited to less than12months,two patients were excluded from the current analysis.
Each patient had a nipple biopsy demonstrating typical Paget cells at the time of diagnosis.A central pathology review was not performed.Thirty-three women were diagnosed with American Joint Commit-tee on Cancer TisN0M0,Stage0Paget disease of the breast.15Two patients were diagnosed with T1N0M0, Stage I Paget disease,one with microinvasion and one with invasive ductal carcinoma measuring0.5cm.One patient had T2N0M0,Stage IIA disease with a mam-mographically occult invasive ductal and lobular car-cinoma measuring2.7cm located directly beneath the nipple-areolar complex.
Surgery consisted of either a complete or partial excision of the nipple-areolar complex.Twenty-?ve patients(69%)underwent a complete excision,9pa-tients(25%)a partial excision,and2(6%)underwent a biopsy alone.Final margins were negative in20cases (56%),positive in2(6%),and unknown in14(39%). Fourteen patients(39%)had an axillary lymph node dissection,with a median of13lymph nodes resected (range,8–24lymph nodes),and one patient had a sentinel lymph node biopsy(four lymph nodes were removed).All patients received RT using tangential ?elds to the whole breast.The median dose delivered was50Gy(range,45–54Gy)with median fraction size of2Gy(range,1.8–2Gy).An area of increased dose (underwedging)in the nipple-areolar region was iden-ti?ed in seven RT plans,each with a maximum isodose of106–110%.A boost was delivered to the remaining nipple or tumor bed in97%of cases to a median dose of14Gy(range,9–20Gy).The median total dose to the tumor bed was61.5Gy(range,50.4–70Gy).Of the 35patients receiving a boost,29patients(81%)were treated with electrons,1patient(3%)received both electrons and photons,and3patients(9%)were treated using photons only.Two women(6%)received a boost using a low dose rate interstitial implant.Bolus was used in the photon and/or electron portion of treatment in10cases(27%),bolus was not used in24 Breast Conservation in Paget Disease/Marshall et al.2143
(67%)cases,and it is unknown whether bolus was used in2cases.The location of the placement of bolus was highly variable between institutions.Bolus was applied to the scar or remaining nipple-areolar com-plex during whole breast RT in six patients,to the breast and scar boost in two patients,and to the scar boost only in two patients.In addition to breast irra-diation,one patient received supraclavicular RT to a dose of46Gy and a second patient was treated com-prehensively to the supraclavicular,axillary,and inter-nal mammary lymph nodes to a total dose of50Gy. Two patients(6%)received systemic treatment with tamoxifen.
Patient records were reviewed for the following characteristics:age,menopausal status,presenting symptoms,duration of symptoms,mammographic ?ndings,extent of surgical excision,?nal margin sta-tus,pathologic?ndings,and dissection of axillary lymph nodes with pathologic results.Actuarial curves for local control,disease-free survival,and overall sur-vival were generated using the Kaplan–Meier method measured from the completion of RT.16A local recur-rence as only?rst recurrence was de?ned as a recur-rence in the breast without preceding or simultaneous regional or distant disease.Local recurrence as a com-ponent of?rst recurrence included all patients who developed a breast recurrence either as an isolated recurrence or concurrent with regional and/or distant recurrence.Time to local recurrence was de?ned as the time between completion of RT and the date of recurrence.Patients were scored as having no evi-dence of disease(NED)at last observation if they had been continuously free of disease from the completion of RT to the last follow-up visit or had developed local and/or regional recurrence that was successfully sal-
vaged at the last observation period.For the calcula-tion of cause-speci?c survival,only deaths secondary to breast carcinoma were scored as events.
Paget cases identi?ed since the previous analysis were added to the existing cases,and univariate anal-yses were performed using the Fisher exact test to evaluate the association between clinical characteris-tics and local control.
RESULTS
Clinical and Pathologic Findings
Thirty-six patients with a follow-up greater than12 months were identi?ed.Median age at diagnosis was 51years(range,33–79years).Patient characteristics and mammographic and pathologic?ndings are sum-marized in Table1.All patients were symptomatic at presentation with a median duration of symptoms of9 months(range,1–36months).
Pathologic review at the time of diagnosis re-vealed typical Paget cells of the nipple in all36cases. Thirty cases(83%)had an underlying malignancy.Of the remaining six cases,two patients had no underly-ing breast parenchyma resected and four had no DCIS or invasion present.Among the15patients who un-derwent axillary lymph node surgery,all lymph nodes were pathologically negative for metastatic disease.
Of six patients with mammographic calci?cations (17%),4had a postoperative mammogram.Three showed no residual calci?cations and one showed residual subareolar microcalci?cations.No further surgery was performed on this patient before RT. Local Control,Cosmesis,and Complications
Median follow-up for surviving patients was113 months(range,17–257months).Table2shows the5-, TABLE1
Clinical,Mammographic,and Pathologic Characteristics
Characteristic No.of patients(%)
Menopause status
Premenopausal14(39) Perimenopausal1(3) Postmenopausal20(56) Unknown1(3) Presenting symptoms
Eczematous changes21(58)
Nipple discharge12(33) Erythema10(28) Ulceration5(14) Mammographic?ndings
Negative for malignancy27(77) Abnormality detected a8(23)
Nipple thickening3
Subareolar calci?cations only3
Breast calci?cations elsewhere3
Extent of nipple-areolar excision
Complete nipple-areolar complex25(69)
Partial nipple-areolar complex9(25) Incisional biopsy only2(6)
Final margin status
Negative20(56)
Positive2(6)
Unknown14(38) Underlying malignancy30(83)
DCIS only27(75)
DCIS and invasive carcinoma2(6)
Invasive carcinoma only1(3)
T stage
Tis33(92)
T12(6)
T21(3)
DCIS:ductal carcinoma in situ.
a One patient had both nipple thickening and subareolar calci?cations.
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10-,and 15-year actuarial local control rates for the breast as the only site of ?rst recurrence and as a component of ?rst recurrence.Actuarial curves for local recurrence are presented in Figure 1.
Four of 36patients (11%)developed local disease recurrence 21–69months after completion of RT.Sur-gical margins at primary surgery were negative in two patients and unknown in the other two patients.All patients had undergone complete resection of the nip-ple-areolar complex at primary surgery,although a postoperative mammogram showed residual subare-olar microcalci ?cations in one patient.All were suc-cessfully salvaged by mastectomy.Pathologic ?ndings indicated DCIS only in two patients and DCIS with invasive disease in the remaining two patients.
Two additional patients (6%)developed an in-breast recurrence simultaneously with either regional or distant recurrence.Pathology revealed invasive and intraductal disease in both cases.Time to local recur-rence for these patients was 69months and 122
months,respectively.Both had a partial nipple-areolar complex excision at primary surgery with ?nal margin status unknown.One woman experienced a simulta-neous breast and axillary lymph node recurrence and was treated by mastectomy and axillary lymph node dissection followed by chemotherapy and tamoxifen.She has remained free of disease at last follow-up 11.9years after disease recurrence.The second patient had a simultaneous recurrence in the breast and contralat-eral axilla 10.5years following initial diagnosis.A di-agnostic biopsy of the treated breast was performed at that time.It con ?rmed recurrent disease,but no at-tempt was made to perform a mastectomy.The pa-tient died with disease 5.5years following recurrence.
At the time of last follow-up,local disease control was obtained for 35of 36patients (97%),either by primary treatment (30of 36;83%)or salvage surgery (5of 5patients).Actuarial curves of local control with and without surgical salvage are shown in Figure 2.None of the patients with evidence of invasive carci-noma at the time of primary surgery experienced dis-ease recurrence.
Univariate analysis for local failure as a compo-nent of ?rst failure was performed for a number of clinical,pathologic,and treatment factors (Table 3).No factors signi ?cantly predicted the risk of local dis-ease recurrence.
Cosmesis was assessed using the criteria sug-gested by Harris et al.17Ten of 31patients (32%)were considered by the treating radiation oncologist to have an excellent result,including 4patients who under-went nipple reconstruction after complete nipple-are-olar resection.Eighteen patients (58%)were consid-ered to have a good result and 3patients (10%)a fair result.
TABLE 2
Actuarial Local Control Rates for the Breast as the Only Site of First Recurrence and as a Component of First Recurrence
Year
Control rate (%)
95%Con?dence interval
Breast as only site of recurrence 59180–100108775–9915
87
75–99Component of ?rst recurrence 59180–100108369–9715
76
58–94
FIGURE 1.Actuarial rates of local recurrence in the breast as the only site
of ?rst recurrence and as a component of ?rst failure.
FIGURE 2.Actuarial rates of local control with and without surgical salvage.
Breast Conservation in Paget Disease/Marshall et al.
2145
Complications were assessed in32of36cases, with91%(29patients)having no long-term complica-tions.In addition,one patient developed protracted chest wall pain,one developed chronic breast infec-tion,and one possible radiation dermatitis requiring steroids.
Cause-Speci?c and Overall Survival Rates
At last follow-up,32of36patients(89%)had NED. Two patients(6%)died with disease,and2died free of disease.The two patients who died with disease both had a previous breast recurrence.One woman had a simultaneous recurrence in the contralateral axilla and the second patient had a breast cancer recurrence 69months after completion of RT and underwent a successful salvage mastectomy.However,she devel-oped bone metastases22months after breast recur-rence and died5months thereafter.
Actuarial curves for cause-speci?c survival and overall survival at5,10,and15years are provided in Figure3.The actuarial rate for breast carcinoma-spe-ci?c survival was97%at5,10,and15years(95% con?dence interval[CI],90–100%).Actuarial rates for overall survival were93%(95%CI,84–100%)at5years and90%(95%CI,78–100%)at10and15years.One patient with disease died at15.6years,giving an over-all survival beyond15years of75%(95%CI,46–100%). DISCUSSION
The current study represents an update of the collab-orative series reported by Pierce et al.14of patients with Paget disease of the breast presenting without a palpable mass or mammographic density treated with BCS and RT.In the Pierce et al.report,the5-and 8-year local control rates with the breast as the only site of?rst recurrence were91%and84%,respectively, the5-and8-year disease-free survival rate was95%, and the8-year cause-speci?c overall survival rate was 100%.These results suggested that for selected pa-tients with Paget disease of the breast,BCS and RT was a viable alternative to mastectomy.In the current ar-ticle,the local control rate of87%at10and15years, the cause-speci?c survival rate of97%at10and15 years,and the overall survival rate of90%at10and15 years add further support to the original conclusions.
Small series have shown increased rates of recur-rence in the breast following BCS only,with rates of recurrence of20–60%at12–19months following sur-gery.18–20A recent report by Polgar et al.21of33pa-tients identi?ed in the database of the National Insti-tute of Oncology,Budapest,Hungary,as being treated with cone excision alone represents the largest series ever reported of BCS only.The median age of the patients in their study was65years compared with a median age of51years in the current study.Ninety-
TABLE3
Univariate Analyses for Local Recurrence
Clinical factor No.of
patients
Local
recurrence(%)P a
Mammographic?ndings
Negative2719?0.99 Calci?cations813
Not done10
Extent of nipple-areolar excision
Complete nipple-areolar complex25160.65 Partial nipple-areolar complex922
Not done20
Final margin status
Negative2010?0.99 Positive20
Unknown1429
Pathologic results
Paget disease only600.56 Paget disease with DCIS with/without
invasion3020
Breast dose(Gy)
?501315?0.99?502317
Dose to tumor bed with boost(Gy)
?6040?0.99?603219
Use of bolus
Yes10300.33 No2413
Unknown20
Gy:gray.
a
Fisher exact test computed for known clinical factor categories only.FIGURE3.Actuarial rates of cause-speci?c survival and overall survival.
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one percent of cases in the Polgar et al.study were not associated with a palpable mass,compared with100% in the current study.In addition,DCIS was identi?ed in91%of cases versus75%in the current study.There were no cases of invasive cancer identi?ed in the series from Hungary.With a median of6.0years of follow-up(range,2–14years),the crude local recur-rence rate was33%(11of33),with a5-year actuarial recurrence rate of28%.Disease recurrence was inva-sive in10of the11patients.Six of these patients developed distant metastases and all have subse-quently died of breast carcinoma.These data demon-strate that Paget disease of the breast should not be treated with cone excision only.As stated by the au-thors,“RT is mandatory after breast-conserving sur-gery to maintain adequate local control”(p.1905).21 Although direct comparisons cannot be made across series,similar clinicopathologic characteristics be-tween the patients in the surgery-only series and the current study suggest a signi?cant reduction in ipsi-lateral breast recurrence and improvement in disease-speci?c survival in patients treated with breast irradi-ation.
Other studies have reported the outcome of Paget disease treated with limited surgery and de?nitive RT.10,12,22In a recent report,the European Organiza-tion for Research and Treatment of Cancer(EORTC)22 presented their results of a cohort of61patients with Paget’s disease treated with BCS and RT.With a me-dian follow-up of6.4years,the5-year local recurrence rate was estimated to be5.2%compared with the9% local recurrence rate in the current study.Again,dif-ferences in patient selection and treatment between the two studies preclude direct comparisons between the results.However,some differences should be un-derscored.The median age of patients in the current study was51years compared with58years in the EORTC study.The EORTC study included patients with a palpable lesion but excluded patients with his-tologic evidence of invasive carcinoma,which was present in8%of patients in the current study.All patients in the EORTC study received a complete ex-cision of the nipple-areolar complex and margins were required to be histologically tumor free.This com-pares to a complete nipple-areolar excision in69%of patients in the current study with only56%of speci-mens with margins known to be free of microscopic disease.Repeat mammography was performed in all EORTC patients6weeks postoperatively before RT whereas only four of the six patients with suspicious calci?cations underwent repeat mammography be-fore RT in the current study.Although susbsequent analyses of the EORTC study are required to assess sustained rates of local control,we concur with the need to obtain negative margins of excision and a postbiopsy mammogram negative for residual suspi-cious microcalci?cations before proceeding with breast conservation.These recommendations are in keeping with current practice guidelines in the treat-ment of both invasive cancer and DCIS.
In almost all patients diagnosed with Paget dis-ease of the breast,underlying carcinoma,either inva-sive or intraductal,will be identi?ed which will deter-mine prognosis.In patients with Paget disease and no palpable or mammographic mass,the majority will have underlying DCIS.Therefore,axillary lymph nodes are generally pathologically negative as shown in the current report,and treatment should be di-rected to the breast.For patients with Paget disease presenting with nipple changes alone,the available data support treatment consistent with an assumed underlying DCIS.Conservative management of DCIS using BCS and RT has been highly successful.Two randomized trials have demonstrated signi?cant re-duction in the risk of local recurrence including inva-sive recurrence in patients receiving whole breast RT following lumpectomy.7,8Rates of local control in these series have approximated90%at5years,similar to the91%rate in the current study.
Long-term follow-up data are particularly impor-tant for patients with DCIS because DCIS generally has a longer median time to recurrence than invasive carcinoma.In addition,the median time to recurrence following lumpectomy and RT for DCIS is longer than that following lumpectomy alone.7,23One report sug-gested a median time to recurrence of8years or more.24Solin et al.25reported that patients with mam-mographically detected DCIS treated with BCS and RT had a15-year cause-speci?c survival rate of98%,with an overall survival rate of92%.These rates are com-parable to those found in the current study,in which the15-year cause-speci?c survival rate was97%and the overall survival rate was90%.The15-year rate of local-only recurrence as?rst recurrence was14% compared with13%in the current study and the me-dian time to local recurrence was5years.This was also a multi-institutional collaborative study with a median follow-up of9.4years.With the selection cri-teria used in the current study,the long-term results of patients with Paget disease of the breast treated with de?nitive irradiation are highly concordant with re-sults achieved in patients with known DCIS.
Treatment of DCIS by mastectomy,previously the treatment of choice,does not necessarily result in a 100%cure rate.A metaanalysis of mastectomy pa-tients reported a breast carcinoma-speci?c mortality Breast Conservation in Paget Disease/Marshall et al.2147
rate of1.7%at8.6years of follow-up.26Similarly,the use of mastectomy for Paget disease has also re-sulted in high rates of local control and surviv-al.2,27,28Some studies,however,report invasive re-currences following surgery.Dixon et al.2reported a 5%rate of locoregional invasive recurrence in2of 37patients with Paget disease of the breast present-ing without a palpable mass following mastectomy. These patients were successfully salvaged however, and remain disease free after8years of follow-up. Although the use of mastectomy may result in im-proved local control compared with breast-conserv-ing therapy,there are obvious cosmetic and psycho-logical consequences.Breast-conserving treatment for Paget disease and DCIS must aim to minimize local recurrence and achieve excellent rates of dis-ease-free and overall survival as demonstrated in the current study.The extent of resection and the adequacy of margins are known factors predictive of local control in the conservative management of DCIS.29,30Although the current study was unable to demonstrate any statistically signi?cant difference in local control for the clinical factors studied,com-plete excision of all underlying carcinoma should be one of the aims of treatment.For this reason,the authors continue to recommend that the treatment of Paget disease should include excision of the en-tire nipple-areolar complex,achievement of nega-tive microscopic margins,and removal of all suspi-cious microcalci?cations seen on pre-treatment mammograms before proceeding with de?nitive RT.
To the best of our knowledge,the current study has the longest median follow-up of any reported se-ries of patients treated with BCS and de?nitive RT for Paget disease of the breast.Identi?cation of factors associated with local recurrence was not possible in the current study due to the limitations of the small sample of patients and variation in treatment due to the collaborative nature of the study and the time period over which the cases were collected.Other limitations include incomplete information regarding the?nal pathology margins in39%of the patients in this series and the absence of a post-operative mam-mogram to rule out residual microcalci?cations in all patients presenting with suspicious microcalci?ca-tions.Despite these limitations,this study demon-strates excellent rates of local control,cause-speci?c survival,and overall survival at10and15years.The authors con?rm that BCS and RT is an appropriate alternative to mastectomy in women with Paget dis-ease of the breast presenting without evidence of a palpable mass or mammographic density.REFERENCES
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结核病工作职责-方案
督导管理人员的职责 1.应根据患者实际情况确定服药地点和时间，面视患者服药。 2. 患者如未按时服药，应及时采取补救措施。 3. 每次督导服药后按要求填写“肺结核患者治疗记录卡”。 4. 一旦发现患者出现不良反应或中断用药等情况，及时报告结防所。 5. 督促患者定期复查，协助收集痰标本。 6. 患者完成全程治疗后，应将“肺结核患者治疗记录卡”上交至乡镇卫生院，转送至县结防机构归档保存。
结核病工作实施方案 为了进一步加强本乡镇结核病防治工作，控制结核病的传播和流行，保障人民群众身体健康，促进经济和社会发展，结核本乡镇实际，制定本实施方案。 一、结核病流行与防治工作现状 结核病是严重危害人民身体健康的经呼吸道传播的慢性传染病，为全球所关注。我国是世界上22个结核病高负担国家之一，结核病患者数量居世界第二位结核病已被国家列为重点控制点的重大疾病之一。本乡镇结核病疫情的波动有几个特征：一是外来流动人口导致新发病例的增加、管理难度加大；二是家庭经济困难无法完成疗程；三是多耐药结核病的增加使结核病治愈变得更加复杂；四是结核病合并其他疾病的双重感染使结核病难以治愈。因此必须进一步加大结核病防治力度，全面有效的实施现代结核病控制策略，把结核病对人民健康的危害以及对本市经济和社会发展的影响降到最低限度。 指导原则 政府领导、部门合作、全社会参与、卫生部门管理，共同做好结核病防治工作。 坚持“预防为主，防治结合”的方针，加强结核病人发现和结核病人定点治疗 工作 因地制宜、条块结合，落实病人的督导管理和健康教育。 全面实施现代结核病控制策略，提高防治效果。 加强结核病防治宣传培训，提高市民健康知识知晓度和主动就诊意识。 （一）实行结核治疗费用“收、减、免”政策，控制传染源。 二、总体目标 （一）建立和完善本乡镇结核病防治工作的可持续发展机制。 （二）以乡镇为单位实行现代结核病控制策略的覆盖率达到１００％，并不断提高内涵质量。（三）完成本乡镇肺结核病人治疗任务。 三、工作指标 进一步减少结核病感染、患病和死亡，切实降低结核病疾病负担，提高人民群众讲课水平，促进国民经济发展和社会和谐稳定。 （一）村卫生室对可疑肺结核及肺结核病人的转诊率、活动性肺结核病人归口诊治率达到９5％以上；新发现活动性肺结核患者规则治疗率达到95％。 （二）新发现活动性肺结核病患者村负责督导管理的覆盖率达到８5％。 （三）新发现活动性肺结核患者的治愈率达到８５％以上。 四、主要措施 （一）健全结核病防治网络，提高结核病防治能力 根据预防归口、功能对应、防治结合、归口管理、各司其职的原则，不断加强本辖区疾病预防控制体系及结核病防治网络的建设，充实和稳定结核病防治专业技术队伍，提高防治技术水平。结核病诊治指定医疗机构必须按照“谁治疗、谁管理”的防治工作原则，落实结核病病人资料的规范管理，执行结核病标准化疗方案，加强对病人健康教育，实施定期配药、定期复查及服药监测等管理工作，确保治疗效果。 开展辖区内结核病人的化疗督导管理及健康教育。对辖区内新发现的活动性肺结核病人，必须明确专人承担化疗督导管理。病人所在的单位也要督促病人及时就诊，使病人得到全程、规范治疗。 （二）积极发现和治疗肺结核患者
Paget病
Paget病 一、概念：Paget病(Paget's disease)又名湿疹样癌(eczematoid carcinoma)，为临床上表现为湿疹样皮损，病理上表皮内有大而淡染的异常细胞(Paget细胞)为特点的一种特殊型癌，可分为二型：①乳房Paget病(mammary Paget’s disease), 发生于乳头及乳晕部；②乳房外Paget病(extramammary Paget's disease)，常见于顶泌汗腺分布区，如女阴、男性生殖器、肛周、腋窝等。 二、病因病因未明，目前多认为本病起源于乳腺导管及顶泌汗腺导管开口部原位癌，并从该处向下沿乳腺导管及腺上皮扩展，最终可侵入结缔组织；向上则扩展到表皮内而形成Paget病皮损。 三、临床表现 1．乳房Paget病几乎均见于妇女，好发于单侧乳房和乳晕部，平均发病年龄为55岁，极少数见于男性乳房。皮损初发为鳞屑性红斑或斑块，常伴有湿疹化，呈表浅糜烂、渗出或结痂，浸润明显，缓慢向周围扩大，可形成溃疡和乳头回缩。常伴发乳腺癌，可伴腋窝淋巴结转移。 2．乳房外Paget病见于两性，但以女性为多。平均发病年龄大于乳房Paget病。大多见于女阴，其次为阴囊、会阴、肛周，亦见于阴部以外顶泌汗腺区（如腋窝等）。皮损和乳房Paget病相似，呈界限清楚的红色斑片或斑块，表面呈湿疹样，糜烂、渗出或结痂。较乳房Paget病的皮损大，且常有痛痒感。乳房外Paget病一般较乳房Paget病预后好，但可伴发真皮内侵袭性癌。由直肠腺癌扩展到肛周皮肤，或由分泌粘液的宫颈癌扩展到外阴部者，则称为继发性乳房外Paget病，预后不良。 四、组织病理：特点为：①表皮内有单个或呈巢状排列的Paget细胞，胞体大，圆形或椭圆形，无细胞间桥，细胞内含一个大的胞核，胞质丰富而淡染，甚至空泡状。②Paget细胞增多时，可将周围表皮细胞挤压成网状，特别是常将表皮基底细胞挤压成细带状。③Paget细胞PAS反应阳性，耐淀粉酶。 ④真皮内伴有慢性炎症细胞浸润。 五、诊断：中老年人单侧乳房或顶泌汗腺分布区发生湿疹样斑片，境界清楚，基底有浸润，病程缓慢，持久存在，按湿疹治疗无效，均应怀疑本病，病理活检可以确诊。 六、治疗：乳房Paget病应进行乳房切除术，如伴发乳房内肿块，应进行乳房根治术。乳房外Paget 病应进行广泛深切除，以免复发。 骨科Paget's病 Paget与Virchow并称为近代病理学之父。Paget的生活年代是19世纪，他的重要贡献包括肿瘤生长的“种子-土壤学说”，骨科的Paget病，乳腺的Paget病，外阴Paget病，阴囊等paget病，骨
男人阴囊潮湿的主要原因.doc
男人阴囊潮湿的主要原因 男性朋友们在面对巨大的压力之下，导致很多的男性朋友患上了男科疾病。其中男性疾病，阴囊潮湿是非常常见的，那么，是什么呢?以下是我为你整理有关于，希望能帮到你。 1、脾虚湿重 从中医角度来说，第一种就是我们说的这个脾虚湿重。中医认为人的水液代谢主要是三个脏腑，第一个肺、第二个脾，第三个是肾，是一些脾虚的人，由于脾主运化，中医说脾的功能是管消化吸收的，人吃了以后，食物和水都通过脾输送到身体各个部位。有先天的方面，比如父母的遗传，在脾的功能这块就弱一点。 2、后天失调 第二种就是后天失调，比如后天由于身体不好，经常得病，或者是饮食不好，或者等等原因。当脾的功能不好以后，运化功能就不好了，不能浸润(我们说脾能浸润)。水湿运化不了，有一部分从肠子走了，脾虚的人经常出现大便溏泄，还有脾虚的人容易造成阴囊等出现潮湿，这都是水湿运化不好，脾虚所造成的。 3、下焦湿热 第三就是下焦湿热，也可能是人内脏功能失调所造成的，也可能是因为自然气候所造成的，也可能是因为，饮食不洁，或者饮食这方面自己不能
把饮食调整好了造成的。比如爱喝酒的人，爱吃辣东西的人，这样的人就经常地是湿热特别大，吐出舌头来，苔特别厚腻，粘粘糊糊小便黄，这经常阴囊潮湿。和他的饮食有关系，当然和气候有关系，经常阴雨连绵，湿热的天气，加上脾虚的人阴囊更加潮湿了。 阴囊潮湿引起的症状表现 1、急性阴囊潮湿 急性阴囊潮湿的主要表现为阴囊皮肤弥漫性肿胀并发红，还伴有剧烈的瘙痒感，可以同时出现很多针头至芝麻粒大小的丘疹或者水疱。经搔抓或摩擦后，红斑、丘疹、水疱破裂，显露出大片湿润糜烂，有大量淡黄色浆液渗出，部分凝结成对淡黄色痂。一般经2—3周，红肿减轻，渗液减少，逐渐完全愈合，但容易复发。 2、亚急性阴囊潮湿： 亚急性阴囊潮湿是由急性阴囊潮湿转变而来，表现为阴囊皮肤轻度变厚和轻度糜烂，鳞屑较多，渗液甚少，仍有剧烈瘙痒。 亚急性阴囊潮湿未及时治疗，迁延日久，或者反复发作，可转变为慢性阴囊潮湿。表现为阴囊皮肤逐渐增厚粗糙，呈暗红或灰褐色，皱褶肥大，呈核桃壳状，有鳞屑附着，在病程中又可因剧痒瘙抓后出现糜烂、渗液等急性或亚急性阴囊潮湿的症状。 3、慢性阴囊潮湿： 慢性阴囊潮湿由急性、亚急性湿疹长期不愈、反复发作而来。亦有少数起病即为慢性者。皮损境界明显，炎症改变不显著，主要表现为皮肤肥厚，粗糙，嵴沟明显，干燥，脱屑，呈苔藓样变，皮色呈暗红或深褐色，有抓
结核病健康管理服务规范方案
肺结核患者健康管理服务规范 一、服务对象 辖区内确诊的肺结核患者。 二、服务内容 （一）筛查及推介转诊 对辖区内前来就诊的居民或患者，如发现有慢性咳嗽、咳痰≥2周，咯血、血痰，或发热、盗汗、胸痛或不明原因消瘦等肺结核可疑症状者，在鉴别诊断的基础上，填写“双向转诊单”。推荐其到结核病定点医疗机构进行结核病检查。1周内进行电话随访，看是否前去就诊，督促其及时就医。 （二）第一次入户随访 乡镇卫生院、村卫生室、社区卫生服务中心（站）接到上级专业机构管理肺结核患者的通知单后，要在72小时内访视患者，具体内容如下：（1）确定督导人员，督导人员优先为医务人员，也可为患者家属。若选择家属，则必须对家属进行培训。同时与患者确定服药地点和服药时间。按照化疗方案，告知督导人员患者的“肺结核患者治疗记录卡”或“耐多药肺结核患者服药卡”的填写方法、取药的时间和地点，提醒患者按时取药和复诊。 （2）对患者的居住环境进行评估，告诉患者及家属做好防护工作，防止传染。 （3）对患者及家属进行结核病防治知识宣传教育。 （4）告诉患者出现病情加重、严重不良反应、并发症等异常情况时，要及时就诊。 若72小时内2次访视均未见到患者，则将访视结果向上级专业机构报告。 （三）督导服药和随访管理 1. 督导服药 （1）医务人员督导：患者服药日，医务人员对患者进行直接面视下督导服药。 （2）家庭成员督导：患者每次服药要在家属的面视下进行。 2. 随访评估 对于由医务人员督导的患者，医务人员至少每月记录1次对患者的随访评估结果；对于由家庭成员督导的患者，基层医疗卫生机构要在患者的强化期或注射期内每10天随访1次，继续期或非注射期内每1个月随访1次。 （1）评估是否存在危急情况，如有则紧急转诊，2周内主动随访转诊情况。
简述Paget's病
门诊经常会接待乳头出现湿疹样改变的患者，也有些病理已经确诊乳腺Paget's病，由于此病在临床相对少见，又容易出现误诊，患者常常疑虑较多。因此，综合了一些患者比较关心的问题，在此对乳腺Paget's病做一个有针对性的介绍，希望能对患者有所帮助。 怎样诊断乳腺Paget's病？ 乳腺Paget's病又称乳腺湿疹样癌，是一种特殊类型的乳腺癌，恶性程度较低，发病率也低。这种病首诊容易误诊，原因是：与真正的乳头湿疹容易混淆。乳腺Paget's病早期主要表现是乳头皮肤发红、瘙痒、微痛，有的患者还有少量渗出，继而出现乳头乳晕区皮肤增厚、渗液、结痂、脱屑或有乳头乳晕皮肤糜烂、溃疡。这种情况经皮肤科医生对症处理后可暂时性痂下愈合，并可多次复发。所以，当女性反复出现皮肤湿疹样改变时，一定要做考虑到是否患有乳腺Paget's病。一般建议乳头乳晕区皮肤病损治疗超过2周疗效不明显者，应做病理检查排除乳腺Paget's病。由于此病经常伴有乳腺导管内癌或浸润性导管癌，所以还要做乳腺超声或钼靶检查，以发现乳腺内的病变，避免漏诊。 诊断乳腺Paget's病要根据临床表现和病理学检查，记住一定要做病理学检查，以找到Paget's细胞为确诊依据。常用的有细胞学检查和取病变部位皮肤全层的病理检查。 细胞学检查是无创检查，一般先揭去皮损部位的痂皮，清除分泌物后，再做细胞印片，如果伴随有乳头溢液的症状，还应该做溢液涂片检查，多次细胞学检查有助于提高诊断准确率。但是，细胞学检查阴性不能排除此病。 病损皮肤的全层活检是最可靠的确诊方法，就是从取病损处切取一小块全层皮肤做病理检查。虽然，这是有创性检查，但是诊断率高。取皮肤活检损伤很小，门诊就可以操作，不需要住院，伤口1周左右就可以愈合。如果病理检查阳性就可以100%确诊了。如果反复病理检查都是阴性，基本可以排除此病。但是对高度怀疑此病的患者，建议还要详细检查乳腺，
睾丸肿瘤样病变简介
睾丸肿瘤样病变简介 一.概述 1.睾丸肿瘤并不常见，仅占全身恶性肿瘤的1%。欧美发病率较高，中国较低。①70年代以后治疗上有突破性进展，使死亡率从50%降至10%。②是15～35岁青年最常见癌，因为年轻人所以能承受手术、放疗、左右化疗等严格的综合治疗。③有分化的倾向，自发的或治疗后由恶性变为良性，如转移癌经化疗后转为良性畸胎瘤。若能弄清其机制，有可能使恶性肿瘤分化为良性肿瘤。④肿瘤分泌标记物质，可以从血中查出，其他肿瘤不常见。 2.肿瘤标记物价值有限，又禁穿刺活检 3.生殖系统对放射线特别敏感，因此CT、同位素均不宜采用。故以超声检查为宜。 病因 4.隐睾：其发生肿瘤的机会比正常人高20倍～40倍。腹内隐睾（22.7%）；腹股沟隐睾（6.7%）。采取隐睾经睾丸固定术，10岁前手术可明显减少，3岁前手术能避免发生肿瘤。 5.遗传：16% 6.多乳症：4-5倍 7.睾丸女性综合征：40倍 8.外伤、激素、感染 二.病理 睾丸肿瘤组织分类 1.生殖细胞肿瘤 （1）精原细胞瘤；典型精原细胞瘤；间质型精原细胞瘤；精母细胞瘤性精原细胞瘤。（2）胚胎癌。（3）畸胎瘤（有无恶性变。）（4）绒膜上皮癌。（5）卵黄囊肿瘤（内胚窦、胚胎性腺癌）。 2.非生殖细胞肿瘤 （1）性腺基质肿瘤；间质细胞瘤；支持细胞瘤。（2）性腺胚细胞瘤。（3）
其他类型肿瘤；睾丸网腺瘤；睾丸腺癌；间质性肿瘤；类癌；肾上腺残留肿瘤。 3.继发性肿瘤 （1）网状内皮组织肿瘤。（2）转移性肿瘤。 4.睾丸旁肿瘤 （1）腺瘤样肿瘤；（2）附睾囊腺瘤；（3）间质性肿瘤；（4）皮质瘤；（5）转移瘤。 三.临床表现 1.发展缓慢、病情隐匿、无痛性肿大、阴囊触及坚硬肿块——延误半年以上。 2.若突然出现阴囊疼痛性肿块，且伴畏寒、发热、或局部红肿——肿瘤出血、坏死、血管栓塞（误诊急性附睾炎）。 3.5岁以下的儿童以卵黄囊肿瘤与畸胎瘤为主。几乎所有。 4.青少年与成年人一样，以精原细胞瘤、胚胎癌、绒毛膜上皮癌及混合癌常见。 四.诊断 肿瘤标记（瘤标） 1.AFP：正常值<40ng/ml，全部卵黄囊瘤，50%～70%胚胎癌、畸胎癌时升高 纯绒癌和纯精原细胞瘤不升高。 2.HCG：正常值<1ng/ml，全40%～60%胚胎癌HCG阳性，“纯”精原细胞瘤5%～10%阳性。 3.应用以上两种瘤标检查，非精原细胞瘤90%有其一或两都阳性。纯精原细胞瘤HCG阳性占5%～10%，即90%以上纯精原细胞瘤不产生瘤标，非精原细胞瘤不产生瘤标者10%，所以一旦临床上诊断睾丸肿瘤后应立即行睾丸切除术，不必等候瘤标结果。 4.瘤标可作为观察疗效的指标，手术或化疗、放疗后迅速下降则预后较好，下降缓慢或不下降者可能有残余肿瘤。 五.治疗措施 1、睾丸肿瘤的治疗决定于其病理性质和分期，治疗可分为手术、放疗和化疗。 2、首先应做经腹股沟的根治性睾丸切除术。标本应作详细检查，最好行节
结核的DOT化疗方案
结核的DOT化疗方案 射手王 分享回复该话题发表新话题 1楼 目前比较公认的先进的结核病防治措施是DOT（DirectlyObservedTreatment，直接督导下的短程化疗），结合世界卫生组织推荐的化疗方案，对不同化疗对象，列出几个不同的化疗方案以供选用。 (一)初治菌阳病人 治疗对象：初治菌阳肺结核病人，及伴有空洞或粟粒型初治菌阴肺结核病人。 1、2HRZE(S)/4HR 强化期：异烟肼(H)、利福平(R)、吡嗪酰胺(Z)及乙胺丁醇(E)或链霉素(S)，每日1次，共2个月。 继续期：异烟肼、利福平每日1次，共4个月。 全疗程6个月 2、2HRZE(S)/ 4H3R3 强化期：异烟肼、利福平、吡嗪酰胺及乙胺丁醇(或链霉素)每日1次，共2个月。 继续期：异烟肼、利福平隔日1次(即H3R3为隔日1次或每周3次)，共4个月。 全疗程6个月。 3、2H3R3Z3E3(S3)/4H3R3 强化期：异烟肼、利福平、吡嗪酰胺及乙胺丁醇(或链霉素)隔日1次，共2个月。 继续期：异烟肼、利福平隔日1次，共4个月。 全疗程6个月。 注：(1)在上述3个方案中均列出乙胺丁醇与链霉素两种药物，可任选一种，疗效无明显差异。但乙胺丁醇使用方便，还可避免由于使用注射器所致的交叉感染。建议对成人首
选乙胺丁醇，对儿童为避免导致视力障碍应慎用乙胺丁醇。 (2)应用上述诸方案治疗至第2个月末时，病人痰菌检查如仍为阳性，则应延长1个月强化期，相应缩短1个月的继续期，分别改为：3HRZE(S)/3HR；3HRZE(S)/ 4H3R3； 2H3R3Z3E3(S3)/4H3R3。 (3)如病人治疗至第5个月末仍阳性，至第6个月末痰菌始转阴，应延长2个月的继续化疗期。第8个月末查痰结果为阴性则停止治疗(治愈)；若仍为阳性则列为初治失败，改用复治涂阳化疗方案。 (二)初治涂阴病人 除外有空洞、粟粒型涂阴肺结核病人。 1、2HRZ/4HR 强化期：异烟肼、利福平及吡嗪酰胺每日1次，共2个月。 继续期：异烟肼、利福平每日1次，共4个月。 全疗程6个月。 2、2HRZ/4H3R3 强化期：异烟肼、利福平及吡嗪酰胺每日1次，共2个月。 继续期：异烟肼、利福平隔日1次，共4个月。 全疗程6个月。 3、2H3R3Z3/4H3R3 强化期：异烟肼、利福平及吡嗪酰胺隔日1次，共2个月。 继续期：异烟肼、利福平隔日1次，共4个月。 全疗程6个月。 涂阴病人治疗满疗程，痰菌检查仍为阴性，应归类于"完成疗程"。 (三)复治涂阳病人 1、2HRZES/6HRE 强化期：异烟肼、利福平、吡嗪酰胺、乙胺丁醇和链霉素每日1次，共2个月。 继续期：异烟肼、利福平和乙胺丁醇每日1次，共6个月。 全疗程8个月。
肺结核病的防控宣传教育 活动方案
《肺结核病的防控宣传教育》班会活动方案一、活动主题 保证学生身体健康，预防肺结核。 二、活动目的 1、通过本次班会让学生了解肺结核的相关知识。 2、让学生意识到健康的重要。 三、活动准备 1、主题班会课件。 2、教室黑板布置。 四、活动地点 地点：教学楼406教室 五、活动过程 主持人：冬春季，天气变化大，使呼吸道疾病多发，一旦不注重个人卫生或是公共卫生，很容易造成疾病的产生和蔓延。肺结核做为一种常见疾病，大家对它了解多少，知道什么是肺结核吗？怎么预防呢？今天就让我们一起来学习了解肺结核病的相关知识。 （一）结核病及其主要症状 结核病是结核杆菌侵入人体引起的一种慢性传染病，可在身体各个器官发病，但多发生于肺部。肺结核的主要症状：咳嗽咳痰三周以上，或痰中带血丝，应怀疑得了肺结核病。连续三周以上的咳嗽、咳痰通常是肺结核的一个首要症状，如果同时痰中带有血丝，就有极大的可能是得了肺结核病。
其它常见的症状还有低烧、夜间盗汗、疲乏无力、体重减轻、月经失调等。 1、咳嗽、咳痰：是肺结核的最主要症状； 2、咯血：是肺结核病常见症状之一，从痰中带血到每次多少不一，血色鲜红带泡沫； 3、胸痛：位置不定的隐痛或钝痛，有时胸闷； 4、午后潮热：体温一般38℃左右，午后逐渐升高，夜间出汗。 （二）结核病是怎样传播的，怎样才能控制传播 肺结核病是一种经呼吸道传播的慢性传染病，主要通过病人咳嗽、打喷嚏或大声说话时喷出的飞沫传播给他人，特别是有咳嗽症状的排菌肺结核病人，其传染性最大，是最主要的传染源。健康人吸入了漂浮在空气中的结核杆菌就有可能感染上结核病。 控制结核病传播最有效的措施是尽早发现病人并进行积极有效的治疗。通过药物杀死结核杆菌，降低和消除传染性。此外，病人不要当面对他人咳嗽、打喷嚏或大声说话，必要时用手帕捂住口鼻，不要随地吐痰，居室门窗常开，保持室内通风和空气新鲜。 （三）肺结核的检查诊断 肺结核病是国家列入归口管理的乙类传染病。如出现肺结核病可疑症状应及时到当地疾病预防控制中心（结核病防治机构）接受检查和治疗。 （四）结核病的治疗 国家对传染性肺结核病人实行免费治疗，对咳嗽、咳痰超过2～3周的可疑结核病人实行免费检查，对传染性肺结核
乳房外Paget病
乳房外Paget病 乳房外Paget病( extramammary Paget's dis-ease EPD)，又称乳房外湿疹样癌(extramam-mary ec.zematoia carcinoma), 1874年临床病理学家James Paget首先描述了乳房外Paget病，27年后即19(11年Dubreuilh报告累及外阴的首例乳房外Paget病。这是一种特殊类型的癌性疾病，易发生于富有大汗腺的区域，因其临床表现甚似湿疹，常易误诊。 【病因】尚不清楚。 I.多年来认为本病起源于皮肤，属于皮肤癌前病变，以后恶化侵入乳腺。 2.目前认为是起源于乳腺导管近开口处.早期为原位癌。这种导管内癌向内侵入乳腺或大汗腺上皮，而向外则侵入表皮，形成表皮病变。 3.个别报道可能与汗腺癌有关。 【临床表现】乳房外湿疹样癌通常发生于40-60岁患者，很少在40岁以内者.为境界清楚的红色斑片，表面有渗出结痴或角化脱屑，逐渐向周围扩大。经数月或数年后往往有浸润，甚至发生溃疡.一般有疹痒，因而是一种特殊类型的癌性疾病，易发生于富有大汗腺的区域。常见部位为外阴、阴囊、阴茎、肛周、腹股沟、阴阜。只有个别病例发生于腋窝，盯聆腺或睫降区。作者在1997年发现1例男性乳房外湿疹样癌除阴囊有皮损外两侧腋窝均有轻度红斑、结痴皮损，活检后病理证实为乳房外湿疹样癌。乳房外湿疹样癌常合并其他部位的癌瘤，如胃癌、乳腺癌、直肠癌、子宫颈癌和膀胧癌等。Peng等(1995)报告乳房外11疹样癌是一少见疾病，易复发。1937年由Weine:报告为大汗腺癌，多数病例发生于肛周，生殖器周围及腋部，由于该处汗腺丰富，阴囊是最常见部位。长期存活的患者皮损下方无癌，预后好，若皮损下方有附属器癌则趋向于浸润，预后差。约4(1%可伴其他恶性肿瘤，如前列腺癌、直肠癌、官颈癌、乳腺癌、膀胧癌和皮肤癌。Taddei等(1993)报告8例外阴及肛周湿疹样癌，平均年龄58.8岁，7例是表皮内皮损。仅1例有广泛表皮内侵犯。用原位DNA杂交检测人乳头瘤病毒(HPV) : HPV6, 11, 16, 18, 31, 33, 35，所有病例均阴性，因而说明乳房外湿疹样癌无1-1PV感染a二等(1995)报告1例外阴湿疹样癌.皮损非常小，只有I nun浸润深的乳房外湿疹样癌，但腹股沟淋巴结有广泛转移。Kato等(1996)报告1例日本男性65岁乳房外湿疹样癌有广泛性转移，患者湿疹祥癌发生于左腹股沟区.渐扩展至阴囊、阴茎和耻部，开始为左下肢淋巴结肿大，继而肿瘤播散，系统淋巴结肿大，伴肺、骨胳、左肾上腺转移，头皮部位有转移皮肤结节，乳房外湿疹样癌广泛转移非常少见。在日本仅有其他2例报告。 【组织病理】乳房外湿疹样癌可见棘层肥厚，位于表皮中的Paget细胞大而圆，较正常角阮细胞大1一2倍，无细胞棘突，核大，染色深，核膜清楚，通常只有1个核，但亦可多个核，核位于当中，亦可被挤在细胞的一侧，呈新月形，可见核分裂象。胞浆淡染而丰富.散在或成团分布，亦可形成腺状结构。Paget细胞巢常在钉突尖端明显，表皮中无角化不良细胞、表皮无多核角阮细胞，Paget细胞不从表皮侵入真皮，但可从表皮伸入毛囊上皮中，可伴有小汗腺癌。有的Paget细胞侵及皮脂腺。Helwig见到13例乳房外湿疹样癌有大汗腺癌。北京协和医院王家璧(1985)报告7例乳房外湿疹样癌，其中6例Paget细胞成单个、巢状、索条状、团块状分布于表皮，以表皮钉突尖端较多。5例表皮中Paget细胞成腺状结构，2例单个Paget细胞在角质层中亦见到。2例侵及毛囊及小汗腺。6例PAS及Alrian blue染色均阳性，说明Paget细胞含有中性粘多糖。Kakinuma等(1994)报告1例76岁男性生殖器部位乳房外湿疹样癌，临床表现为4片色素减退斑，组织病理学上有许多不相连散在或群集Paget细胞.在4片皮损处有表皮内小巢状Paget细胞分布至色素减退区与正常色素区。Fontana-Masson染色示色素减退区基底f~缺乏黑色素沉积，而与之相连的正常皮肤的基rK 层一育丰富的黑色素。缺乏黑色素的色素细胞和噬色素细胞位于受侵犯的表皮内及表皮下，
结核病防控工作方案
结核病防控工作方案 为加强学校结核病防控工作，有效防范学校结核病疫情的传播，确保广大师生身体健康与生命安全，特制定本工作方案。 一、指导思想 以科学发展观为指导，充分认识结核病防控工作的重要性与紧迫性，构建“预防为主、防治结合”长效管理与应急处置机制，提高快速反应和应急处理能力，加强领导，密切配合，群防群控，做到“早发现、早报告、早隔离、早治疗”，确保师生安全，确保学校稳定。 二、组织机构 成立“博林实验学校结核病防控工作领导小组”具体成员如下：组长：刘宝明（校长） 副组长：江桥峰（主抓-办公室主任） 成员：赖亮温琼雯许群叶惠燕刘琦各班主任分工如下： 赖亮：负责全校结核病总责及经费落实工作 江桥峰：负责督查结核病健康健康工作的开展 温琼雯：负责具体组织实施结核病健康教育工作 叶惠燕：负责组织教师开展结核病主题班会活动 刘琦：负责做好师生和学生家长结核病情况统计，严防结核病的传染 许群：负责做好班级协调工作，确保安全有效地开展各项活动
具体负责结核病防控工作的实施。 三、工作职责 根据教育行政部门的部署，在卫生部门指导下，将结核病防控纳入学校工作计划；建立“一把手”负总责、分管副校长具体抓的防控工作责任制，并将责任分解到部门、落实到人；明确结核病疫情报告人；配合卫生部门对校医等有关人员进行结核病防控知识培训；开展结核病防控健康教育；配合卫生部门做好结核病暴发疫情处置等工作。 四、常规预防措施 1、开展结核病健康教育。通过健康教育课、主题班会、宣传展板、黑板报、宣传窗，或开展讲座、播放影像制品等形式，对在校学生和教职员工广泛宣传结核病防治的核心知识，提高对结核病的认知水平，增强自我防护意识，减少对结核病患者的歧视。 核心知识包括： （1）肺结核是一种慢性呼吸道传染病； （2）咳嗽、咳痰2周以上，或痰中带血丝，应当怀疑得了结核病； （3）得了结核病，应当到县级结防机构（设县疾病控制中心）接受核查和治疗； （4）在县级结防机构检查和治疗肺结核，可享受国家免费政策； （5）只要坚持正规治疗，绝大多数肺结核患者是可以治愈的； （6）咳嗽、打喷嚏掩口鼻；
什么是阴囊湿疹样癌
什么是阴囊湿疹样癌 可能有一些朋友会听说过阴囊湿疹样癌这种癌症，但是真正了解阴囊湿疹样癌的人肯定是不多的，毕竟阴囊湿疹样癌并不是一种常见的癌症，我们周边也很少有人会患上阴囊湿疹样癌，但是由于阴囊湿疹样癌的危害性很大，所以我们还是有必要多了解一些关于阴囊湿疹样癌的信息，下文我们就来给大家介绍一下什么是阴囊湿疹样癌。 阴囊湿疹样癌是乳房外湿疹样癌的一种，又称为阴囊Paget 病，发病率较低。1894年由Paget首先报道乳房外Paget病，主要发生在大汗腺分布部位如女性外阴、腋窝和外生殖器等。病因目前尚不清楚，可能与大汗腺的腺癌有关。 镜下表现为阴囊皮肤表面角化增厚，表皮内有多数大圆形、空泡状Paget细胞，呈条索状、巢状、岛屿状弥漫性分布。皮下有淋巴细胞浸润，部分区域可见到大汗腺癌，癌细胞可侵犯皮下脂肪，并容易发生腹股沟淋巴结转移。以上病变特征可与阴囊湿
疹区别。有人认为Paget细胞是一种特殊类型的原位癌，癌细胞在基层和基底膜之间向表皮内侵犯，并在表皮细胞间蔓延，形成Paget病。 诊断要点： 根据临床表现及诊断不难，早期诊断很重要。临床表现很容易误诊为阴囊湿疹或皮炎。因此，凡久治不愈的湿疹样阴囊皮肤病变，应及早行组织活检，必要时重复活检。湿疹病变特点为表浅且无高度增殖浸润的Paget细胞。 早期表现： 早期表现为阴囊表面小水疱状皮疹，可能因搔抓破溃而流液。以后病变逐渐向外扩展，由阴囊处累及阴茎根及其周围的下腹部、股部皮肤等。病变处出现乳头状增殖与溃疡渗出交错，有的呈红斑和糜烂相间，有的呈菜花状增殖隆起。表面坏死组织有恶臭分泌物附着，病变与正常皮肤界限清楚。病变严重时向深层扩展，肿块与睾丸粘连。腹股沟淋巴结大多数为炎性肿大，少数为肿瘤转移所致。 在上面的文章里面我们介绍了一种比较少见的癌症，那就是
《结核病化疗方案》
《结核病化疗方案》 、抗结核化学药物治疗（简称化疗） （一）化疗原则 化疗的主要作用在于缩短传染期、降低死亡率、感染率及患病率。对于每个具体患者，则为达到临床及生物学治愈的主要措施，合理化疗是指对活动性结核病坚持早期、联用、适量、规律和全程使用敏感药物的原则。所谓早期主要指早期治疗患者，一旦发现和确诊后立即给药治疗;联合是指根据病情及抗结核药的作用特点，联合两种以上药物，以增强与确保疗效;适量是指根据不同病情及不同个体规定不同给药剂量;规律即使患者必须严格按照化疗方案规定的用药方法，有规律地坚持治疗，不可随意更改方案或无故随意停药，亦不可随意间断用药;全程乃指患者必须按照方案所定的疗程坚持治满疗程，短程化疗通常为6～9个月。一般而言，初治患者按照上述原则规范治疗，疗效高达98%，复发率低于2%。 活动性肺结核是化疗的适应证。对硬结已久的病灶则不需化疗。至于部分硬结、痰菌阴性者，可观察一阶段，若x线病灶无活动表现、痰菌仍阴性、又无明显结核毒性症状，亦不必化疗。 1、早期、联用、适量、规律和全程用药活动性病灶处于渗出阶段，或有干酪样坏死，甚至形成空洞，病灶内结核菌以a群菌为主，生长代谢旺盛，抗结核药物常可发挥最大的杀菌或抑菌作用。病灶局部血运丰富、药物浓度亦当，有助于促使炎症成分吸收、空洞缩小或闭合、痰菌转阴。故对活动性病灶早期合理化疗，效果满意。
实验证明肺内每1g干酪灶或空洞组织中约有结核菌106～1010个。从未接触过抗结核药物的结核菌，对药物的敏感性并不完全相同。大约每105～106个结核菌中可有1个菌因为基因突变而对异烟肼或链霉素耐药。同时对该两种药物均耐药者约在1011个结核菌中仅1个，同时耐3种药物的菌则更少。可见如单用一种药物治疗，虽可消灭在部分敏感菌，但有可能留下少数耐药菌继续繁殖，最终耐药菌优势生长。如联用两种或两种以上药物，耐药菌减少，效果较单药为佳。 用药剂量要适当，药量不足，组织内药物信以达到有效浓度，且细菌易产生继发性耐药。药量过大则易产生不良反应。结核菌生长缓慢，有时仅偶尔繁殖（b、c菌群），因此应使药物在体内长期保持有效浓度。规律地全程用药，不过早停药，是化疗成功的关键。 2、药物与结核菌血液中（包括巨噬细胞内）药物浓度在常规剂量下，达到试管内最低抑菌浓度（mic）的10倍以上时才能起杀菌作用，否则仅有抑菌作用。常规用量的异烟肼及利福平在细胞内外均能达到该水平，称全杀菌剂。链霉素及吡嗪酰胺亦是杀菌剂，但链霉素在偏碱的环境中才能发挥最大作用，且很少渗入吞噬细胞，对细胞内结核菌无效。吡嗪酰胺虽可渗入吞噬细胞，但仅在偏酸性环境中才有杀菌作用，故两者都只能作为半杀菌剂。乙胺丁醇、对氨基水杨酸钠等均为抑菌剂，常规剂量时药物浓度均不能达到mic的10倍以上，加大剂量则容易发生不良反应。 早期病灶内的结核菌大部分在细胞外，此时异烟肼的杀菌作用是最强，链霉素次之。炎症使组织局部ph下降，细菌代谢减慢（c菌
阴囊湿疹的治疗方法 阴囊湿疹病因.doc
阴囊湿疹的治疗方法阴囊湿疹病因 大家有听说过湿疹吧，可是你有听说过阴囊湿疹吗?关于阴囊湿疹的知识你又了解多少呢?故名思议阴囊湿疹是一种男性疾病，所以广大女同胞们可以稍微松一口气了，但是健康问题不容小觑，你身边也许有好多男性朋友或者亲人，他们也许需要你的关心。下面是由我为你带来的“阴囊湿疹的治疗方法阴囊湿疹病因”，内容仅供参考，。 阴囊湿疹的治疗方法阴囊湿疹病因 阴囊湿疹介绍： 阴囊湿疹是阴囊最常见的皮肤病，属于过敏反应，也是男子常见的性器官皮肤病，不是性传播性疾病，它俗称“绣球风”、“胞漏疮”等。该疾病十分顽固，患者常因搔抓、不适当刺激引起疼痛或继发感染。本病分急性，慢性两种，与人们从事的职业、居住的环境有密切的关系，如长期在煤矿、坑道及其他环境潮湿的地点工作的人，长期居住在潮湿的地区或房间的人皆易患此病，也有人认为本病的发生与遗传因素、热水烫洗、性情急躁等因素有关，此病瘙痒严重，并反复发作。 阴囊湿疹病因： 1.过敏体质(25%)： 过敏体质的人，精神长期紧张，情绪变化起伏较大的人易患本病;过敏体质(irritable the physique)一般是将容易发生过敏反应和过敏性疾病而又找不到发病原因的人，称之为“过敏体质”。具有“过敏体质”的人可发生各种不同的过敏反应及过敏性疾病，如有的患湿疹、荨麻疹、有的患过敏性哮喘，有的则对某些药物特别敏感，可发生药物性皮炎，甚至剥脱性皮炎。 2.慢性消化系统疾病(20%)： 患有一些疾病，如慢性消化系统疾病，胃肠功能紊乱，内分泌失常，新陈代谢障碍的人，在外部因素的作用下，也易患本病。胃肠道功能紊乱又称胃肠神经官能症，是一组胃肠综合征的总称，精神因素为本病发生的
结核病化疗方案
一、抗结核化学药物治疗(简称化疗) (一)化疗原则 化疗得主要作用在于缩短传染期、降低死亡率、感染率及患病率。对于每个具体患者,则为达到临床及生物学治愈得主要措施,合理化疗就是指对活动性结核病坚持早期、联用、适量、规律与全程使用敏感药物得原则。所谓早期主要指早期治疗患者,一旦发现与确诊后立即给药治疗;联合就是指根据病情及抗结核药得作用特点,联合两种以上药物,以增强与确保疗效;适量就是指根据不同病情及不同个体规定不同给药剂量;规律即使患者必须严格按照化疗方案规定得用药方法,有规律地坚持治疗,不可随意更改方案或无故随意停药,亦不可随意间断用药;全程乃指患者必须按照方案所定得疗程坚持治满疗程,短程化疗通常为6～9个月。一般而言,初治患者按照上述原则规范治疗,疗效高达98%,复发率低于2%。 活动性肺结核就是化疗得适应证。对硬结已久得病灶则不需化疗。至于部分硬结、痰菌阴性者,可观察一阶段,若X线病灶无活动表现、痰菌仍阴性、又无明显结核毒性症状,亦不必化疗。 1、早期、联用、适量、规律与全程用药活动性病灶处于渗出阶段,或有干酪样坏死,甚至形成空洞,病灶内结核菌以A群菌为主,生长代谢旺盛,抗结核药物常可发挥最大得杀菌或抑菌作用。病灶局部血运丰富、药物浓度亦当,有助于促使炎症成分吸收、空洞缩小或闭合、痰菌转阴。故对活动性病灶早期合理化疗,效果满意。 实验证明肺内每1g干酪灶或空洞组织中约有结核菌106～1010个。从未接触过抗结核药物得结核菌,对药物得敏感性并不完全相同。大约每105～106个结核菌中可有1个菌因为基因突变而对异烟肼或链霉素耐药。同时对该两种药物均耐药者约在1011个结核菌中仅1个,同时耐3种药物得菌则更少。可见如单用一种药物治疗,虽可消灭在部分敏感菌,但有可能留下少数耐药菌继续繁殖,最终耐药菌优势生长。如联用两种或两种以上药物,耐药菌减少,效果较单药为佳。 用药剂量要适当,药量不足,组织内药物信以达到有效浓度,且细菌易产生继发性耐药。药量过大则易产生不良反应。结核菌生长缓慢,有时仅偶尔繁殖(B、C菌群),因此应使药物在体内长期保持有效浓度。规律地全程用药,不过早停药,就是化疗成功得关键。 2、药物与结核菌血液中(包括巨噬细胞内)药物浓度在常规剂量下,达到试管内最低抑菌浓度(MIC)得10倍以上时才能起杀菌作用,否则仅有抑菌作用。常规用量得异烟肼及利福平在细胞内外均能达到该水平,称全杀菌剂。
阴囊湿疹
阴囊湿疹 一、什么是阴囊湿疹 阴囊湿疹是湿疹中最常见的一种，局限于阴囊皮肤，有时延及肛门周围，少数可延至 阴茎。阴囊湿疹是阴囊最常见的皮肤病，属于过敏反应，也是男子常见的性器官皮肤病，不是性传播性疾病。它俗称“绣球风”、“胞漏疮”等，病情十分顽固，患者常 因搔抓、不适当刺激引起疼痛或继发感染。此病瘙痒剧烈，皮疹呈多形性变，容易复发，给患者的生活和工作带来了很大的困扰。 二、阴囊湿疹的发病原因 阴囊湿疹的原因比较复杂，有内部因素和外部因素。过敏体质的人，精神长期紧张、 情绪变化起伏较大的人易患本病；另外，患有一些疾病，如慢性消化系统疾病、胃肠 功能紊乱、内分泌失常、新陈代谢障碍的人，在外部因素的作用下，也容易患本病。 中医认为，风邪、湿邪、热邪、血虚、虫淫等为致病的主要原因，治疗以疏风祛湿、 清热解毒、养血润燥、活血化瘀为原则，以达到驱邪扶正止痒之功效。 阴囊是男子羞于开口的部位，然而，这里的皮肤却又是一个多事的地方，以下疾患常 使阴囊发生瘙痒： 阴囊湿疹阴囊皮肤上出现红斑、丘疹、水泡、糜烂、渗出、结痂等多种病征，病人自 己感觉灼热和搔痒。常由于用力搔抓，热水洗烫而出现急性肿胀或糜烂。此病病程较长，反复发作而使皮肤变厚、粗糙、色素沉着。 股癣阴囊皮肤出现环状红斑，上有脱屑，有剧烈的痒感。病人多同时患有足癣（俗称 脚气）或手癣，并常在阴囊对侧的大腿皮肤上、臀部也有同样的病征。 疥疮阴囊皮肤上出现黄豆大小的结节，在此之前手指缝内、手腕、腰部、下腹部先发 生散在丘疹及水泡，多在夜间出现剧痒。 阴囊神经性皮炎此病与情绪密切相关，当情绪波动时，阴囊部位剧烈搔痒，抓后皮肤 出现丘疹，慢慢联成一片，皮肤增厚、变硬。 核黄素缺乏性阴囊炎常年食用精白米、精白面、多次搓洗米、食青菜切碎泡洗或者长 期腹泻、便秘、食欲不振、挑食、偏食等等，都会引起核黄素缺乏。它的主要表现是：开始时阴囊微红发亮，以后在阴囊缝两侧发生淡红色斑片，上面粘着鳞屑，不久可出 现多个黄豆大小的扁平丘疹，有不同程度的痒感，常合并出现口角炎、舌炎等。 上述几种阴囊的常见皮肤病，患者往往不能分清，治疗方法也各不相同，所以必须请 专科医师诊断，并根据具体病情对症治疗。
结核病治疗方案最新版本
2HRZ/4HR方案：强化期：异烟肼，利福平，吡嗪酰胺；每日一次，2个月。巩固期：异烟肼，利福平，每日一次，4个月。（为初治涂阴肺结核治疗发案） 2HRZSE/4-6HRE方案：强化期：异烟肼，利福平，吡嗪酰胺，链霉素和乙胺丁醇，每日一次，2个月。巩固期：异烟肼，利福平和乙胺丁醇，每日一次，4-6个月。巩固期治疗4个月时，痰菌未转阴，可继续延长治疗期2个月。（为复治涂阳肺结核治疗发案） 2HRZE/4HR方案：强化期：异烟肼，利福平，吡嗪酰胺和乙胺丁醇，顿服，2个月。巩固期：异烟肼，利福平，顿服，4个月。（为初治涂阳肺结核治疗发案）2H3R3Z3E3/4H3R3方案：强化期：异烟肼，利福平，吡嗪酰胺和乙胺丁醇，隔日一次或每周三次，2个月。巩固期：异烟肼，利福平，隔日一次或每周三次，4个月。（同样为初治涂阳肺结核治疗发案） 2H3R3Z3S3E3/6H3R3E3方案：强化期：异烟肼，利福平，吡嗪酰胺，链霉素和乙胺丁醇，隔日一次或每周三次，2个月。巩固期：异烟肼，利福平和乙胺丁醇，隔日一次或每周三次，6个月。（同样为复治涂阳肺结核治疗发案） 请根据肺结核具体病情进行选择，不同病情方案不同 抗结核药物名称英文全称缩写 代表字母 异烟肼Isoniazid INH H 利福平Rifampicin RFP R 链霉素Streptomycin SM S 吡嗪酰胺Pyrazinamide PZA Z 乙胺丁醇Ethambutol EMB E 对氨基水杨酸Paza-aminosalicylate PAS P 丙硫异烟胺(1321Th) Protionamide PTH 1321Th 乙硫异烟胺(1314Th) Ethionamide ？ 1314Th 卡那霉素Kanamycin KM K 丁胺卡那霉素Amikacin AMK A 卷曲霉素Capreomycin CPM C 氨硫脲Thioacetazone Tb1 T 利福喷丁Rifapentine RFT
结核病治疗方案
2HRZ/4HR方案： 强化期： 异烟肼，利福平，吡嗪酰胺；每日一次，2个月。巩固期： 异烟肼，利福平，每日一次，4个月。（为初治涂阴肺结核治疗发案） 2HRZSE/4-6HRE方案： 强化期： 异烟肼，利福平，吡嗪酰胺，链霉素和乙胺丁醇，每日一次，2个月。巩固期： 异烟肼，利福平和乙胺丁醇，每日一次，4-6个月。 巩固期治疗4个月时，痰菌未转阴，可继续延长治疗期2个月。（为复治涂阳肺结核治疗发案） 2HRZE/4HR方案： 强化期： 异烟肼，利福平，吡嗪酰胺和乙胺丁醇，顿服，2个月。巩固期： 异烟肼，利福平，顿服，4个月。（为初治涂阳肺结核治疗发案）方案： 强化期： 异烟肼，利福平，吡嗪酰胺和乙胺丁醇，隔日一次或每周三次，2个月。巩固期： 异烟肼，利福平，隔日一次或每周三次，4个月。（同样为初治涂阳肺结核治疗发案） 方案： 强化期：
异烟肼，利福平，吡嗪酰胺，链霉素和乙胺丁醇，隔日一次或每周三次，2个月。巩固期： 异烟肼，利福平和乙胺丁醇，隔日一次或每周三次，6个月。（同样为复治涂阳肺结核治疗发案） 请根据肺结核具体病情进行选择，不同病情方案不同 抗结核药物名称英文全称缩写代表字母异烟肼IsoniazidINHH利福平RifampicinRFPR链霉素StreptomycinSMS吡嗪酰胺PyrazinamidePZAZ乙胺丁醇EthambutolEMBE对氨基水杨酸Paza-aminosalicylatePASP丙硫异烟胺 (1321Th)ProtionamidePTH1321Th乙硫异烟胺(1314Th)Ethionamide？1314Th卡那霉素KanamycinKMK丁胺卡那霉素AmikacinAMKA卷曲霉素CapreomycinCPMC 氨硫脲ThioacetazoneTb1T利福喷丁RifapentineRFTRt氧氟沙星OfloxacinOFLXO 左氧氟沙星LevofloxacinLVFXL帕司烟肼DipasicDipD紫霉素ViomycinVMV环丝氨酸CycloserineCSCs利福布丁RifabutinRFBRb
阴囊两侧潮湿病因
阴囊两侧潮湿病因 阴囊常见的疾病有很多，在对阴囊疾病治疗上，要先对阴囊问题进行了解，这样治疗方法选择也能够正确进行，对男性阴囊治疗的时候，男性需要积极配合，这个时候男性不能抽烟喝酒，否则对阴囊问题改善没有任何帮助，那阴囊两侧潮湿病因是什么呢，是很多人不清楚的。 阴囊两侧潮湿病因： 普通病因 除了内在的疾病原因外，主要是传统男士内裤的设计不合理所致。 由于男人的身体构造很特别，阴囊会随着温度的变化而伸缩来调节睾丸的温度低于体温2-3度，用手摸下阴囊便会感觉比身体的其他部位更为凉爽，因为睾丸在低于体温2-3度才能使睾丸酮正常的分泌，促进精子的产生。产生高温潮湿的主要原因是内
裤的不合理设计。男人的内裤影响男人非常大，不过因为男人个性上的不拘小节，对于内裤设计不良而产生的不适，经常隐忍并轻视，导致现有市场上所有传统男性内裤，其实皆隐存有很大缺点，比如很多内裤前面都是双层的，将阴茎和阴囊紧紧的包裹着，特别是到了夏天更是导致阴囊潮湿，时间久了引发许多相关的皮肤病和生理机能的疾病。 所以内裤是阴囊产生高温潮湿的主要原因。建议多穿通风透气性好的阴囊袋内裤。 有阴囊瘙痒的情况要积极进行治疗，不要挠搔抓，也不要用肥皂水进行烫洗。当阴囊皮肤奇痒时，抓破后更易造成感染，反复抓挠可导致阴囊皮肤增厚，导致皮炎或湿疹。 反复发作的病因 阴囊湿疹的原因较复杂，过敏体质的人，精神长期紧张、情绪变化起伏较大的人易患本病;另外，患有一些疾病，如慢性消化系统疾病、胃肠功能紊乱、内分泌失常、新陈代谢障碍的人;在外部因素的作用下，也易患本病，如：生活、工作的环境潮湿，空气的湿度比较大;外界刺激，寒冷或炎热，出汗比较多，过度的搔抓等;内裤较紧，或异物磨擦，穿化纤的内裤都可以诱发阴