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Original Article

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∫∑§—¥¬àÕ ¡–‡√ÁßÕß§™“μ‘‡ªìπ¡–‡√Áß∑’Ëæ∫‰¥â§àÕπ¢â“ßπâÕ¬ ºŸâπ‘æπ∏å‰¥â√«∫√«¡√“¬ß“π°“√√—°…“μ—Èß·μà¡°√“§¡ 2544

∂÷ß ∏—π«“§¡ 2554 ¬âÕπÀ≈—ß‡ªìπ‡«≈“ 11 ªï ¡’ºŸâªÉ«¬∑’Ëμ‘¥μ“¡‡«™√–‡∫’¬π‰¥â 102 √“¬ ‚¥¬‰¥â∑”°“√»÷°…“‡™‘ß æ√√≥π“«‘‡§√“–Àå¬âÕπÀ≈—ß æ∫«à“ºŸâªÉ«¬¡’Õ“¬ÿ‡©≈’Ë¬ 59.59 ªï à«π„À≠à¡“æ∫·æ∑¬å¥â«¬°âÕπ‡π◊ÈÕ·≈–·º≈∑’Ë Õ«—¬«–‡æ» ºŸâªÉ«¬√—∫°“√ºà“μ—¥ partial penectomy √âÕ¬≈– 67.6 ·≈– total penectomy √âÕ¬≈– 26.5 º≈°“√

μ√«®∑“ßæ¬“∏‘«‘∑¬“‡ªìπ™π‘¥ well differentiated √âÕ¬≈– 52, moderately differentiated √âÕ¬≈– 39.2 ·≈–

poorly differentiated √âÕ¬≈– 6.9 ºŸâªÉ«¬∑’Ë‰¡à¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫¡’√âÕ¬≈– 52.9 ¡’°“√

·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫√âÕ¬≈– 47.1 ‚¥¬√–¬–‡«≈“‡©≈’Ë¬¢Õß°“√·æ√à°√–®“¬§◊Õ 3.56 ‡¥◊Õπ

‚¥¬√–¬–‡«≈“·æ√à°√–®“¬À≈—ß°“√ºà“μ—¥Õß§™“μ‘π“π∑’Ë ÿ¥§◊Õ 15 ‡¥◊Õπ ªí®®—¬∑’Ë¡’º≈‡°’Ë¬«¢âÕßμàÕ°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ æ∫‡æ’¬ßªí®®—¬‡¥’¬«§◊Õ≈”¥—∫¢—Èπ§«“¡√ÿπ·√ß∑“ßæ¬“∏‘«‘∑¬“¢Õß¡–‡√Áß(tumor differentiation) à«πÕ“¬ÿ·≈–°“√≈ÿ°≈“¡‡©æ“–∑’Ë (T stage) ‰¡à¡’§«“¡ —¡æ—π∏å°—π ªí®®—¬∑’Ë¡’·π«‚πâ¡‡ªìπ Õ¬à“ß¬‘ËßμàÕ°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊ÕßÕ’°ª√–°“√§◊Õ °“√μ√«®æ∫ tumor emboli „π∑àÕ∑“ß‡¥‘ππÈ”-

‡À≈◊Õß·≈–„πÀ≈Õ¥‡≈◊Õ¥¥” (lymphatic and venous embolization) ‚¥¬ºŸâªÉ«¬∑’Ë¡’ªí®®—¬‡ ’Ë¬ßμàÕ°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ ¡§«√‰¥â√—∫°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ÕÕ° (inguinal lymphadenectomy) ∑—π∑’‚¥¬‰¡àμâÕß√Õ„Àâμ√«®æ∫μàÕ¡πÈ”‡À≈◊Õß‚μ°àÕπ

§” ”§—≠: ¡–‡√ÁßÕß§™“μ‘, °“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫, °“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

¡–‡√ÁßÕß§™“μ‘„π‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™

æ‘…≥ÿ‚≈°: ªí®®—¬∑’Ë¡’º≈μàÕ°“√·æ√à°√–®“¬‰ª μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

æß…å»—°¥‘Ï “√‡®√‘≠

°≈ÿà¡ß“π»—≈¬°√√¡ ‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™ æ‘…≥ÿ‚≈°

∫∑π”

¡–‡√ÁßÕß§™“μ‘æ∫‰¥âπâÕ¬ª√–¡“≥√âÕ¬≈– 2 ¢Õß

¡–‡√Áß√–∫∫¬Ÿ‚√«‘∑¬“⁽¹⁾ ‚¥¬¡’Õÿ∫—μ‘°“√≥å·μ°μà“ß°—π‰ª

„π·μà≈– à«π¢Õß‚≈° ‡™àπ„π∫“ß à«π¢Õß‡Õ‡™’¬ Õ—ø√‘°“

·≈–Õ‡¡√‘°“„μâ ®– Ÿß∂÷ß 19 √“¬μàÕª√–™“°√™“¬

100,000 §π ·≈–æ∫πâÕ¬„π¬ÿ‚√ª·≈– À√—∞Õ‡¡√‘°“‡æ’¬ß 0.1-0.9 μàÕª√–™“°√™“¬ 100,000 §π⁽²⁾ „πª√–‡∑»

‰∑¬ æ.». 2544-2546 ¡’Õÿ∫—μ‘°“√≥å (Age - Standard- ized Incidence Rate) 1.2 μàÕª√–™“°√™“¬ 100,000

§π⁽³⁾ ‡™◊ËÕ«à“¿“«– ÿ¢Õπ“¡—¬·≈–¿“«–Àπ—ßÀÿâ¡ª≈“¬

Õß§™“μ‘‰¡à‡ªî¥®–‡ªìπ “‡Àμÿ ”§—≠⁽⁴⁾ ‚¥¬ºŸâªÉ«¬∑’Ë‰¡à

‰¥â√—∫°“√√—°…“¡—°®–‡ ’¬™’«‘μ¿“¬„π 2 ªï ®“°°“√≈ÿ°≈“¡

Õ¬à“ß§«∫§ÿ¡‰¡à‰¥â¢Õß√Õ¬‚√§„πμ”·ÀπàßÕß§™“μ‘ ·≈–

Õ«—¬«–¢â“ß‡§’¬ß ·≈–°“√·æ√à°√–®“¬‰ªÕ«—¬«–Õ◊Ëπ °“√

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μ‘¥μ“¡‡ΩÑ“√–«—ß°“√°√–®“¬¢Õß¡–‡√Áß‰ª¬—ßμàÕ¡

πÈ”‡À≈◊Õß¢“Àπ’∫À≈—ß®“°°“√ºà“μ—¥Õß§™“μ‘ÕÕ°®÷ß‡ªìπ ‘Ëß ”§—≠ ‚¥¬®–μâÕßμ√«®μ‘¥μ“¡¿“«–μàÕ¡πÈ”‡À≈◊Õß

¢“Àπ’∫‚μ∑ÿ° 3 ‡¥◊Õππ“π 2 ªï ∑ÿ° 4 ‡¥◊Õπ„πªï∑’Ë 3 ∑ÿ°

6 ‡¥◊Õπ„πªï∑’Ë 4 ·≈–μàÕ‰ªªï≈–§√—Èß„πªï∑’Ë 5^(1,7) ·μà„π

°“√»÷°…“μàÕ¡“æ∫«à“°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß

¢“Àπ’∫À≈—ß®“°°“√μ√«®æ∫«à“μàÕ¡πÈ”‡À≈◊Õß‚μπ—Èπ ºŸâªÉ«¬®–¡’Õ—μ√“°“√√Õ¥™’«‘μ 5 ªï√âÕ¬≈– 36 ‡¡◊ËÕ‡∑’¬∫

°—∫°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß∑—π∑’‚¥¬‰¡à√Õ„ÀâμàÕ¡

πÈ”‡À≈◊Õß‚μ°àÕπ ºŸâªÉ«¬®–¡’Õ—μ√“°“√√Õ¥™’«‘μ 5 ªï

√âÕ¬≈– 83⁽⁷⁾ πÕ°®“°π’È°“√μ√«®μàÕ¡πÈ”‡À≈◊Õß‚μ‚¥¬

„™âÕ“°“√∑“ß§≈‘π‘°¬—ß¡’§«“¡‰¡à·πàπÕπ ‚¥¬∑’ËºŸâªÉ«¬∑’Ë μ√«®æ∫«à“μàÕ¡πÈ”‡À≈◊Õß‚μ æ∫«à“‡¡◊ËÕμ√«®™‘Èπ‡π◊ÈÕ

∑“ßæ¬“∏‘«‘∑¬“®–¡’º≈≈∫√âÕ¬≈– 33 ·μàºŸâªÉ«¬∑’Ëμ√«®

‰¡àæ∫μàÕ¡πÈ”‡À≈◊Õß‚μ®–¡’º≈∫«°∑“ßæ¬“∏‘«‘∑¬“√âÕ¬≈–

20⁽⁸⁾ ®÷ß¡’º≈°“√»÷°…“∑’Ë·π–π”„Àâ∑”°“√ºà“μ—¥‡≈“–

μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ „π√“¬∑’Ë¡’§«“¡‡ ’Ë¬ß‚¥¬‰¡à√Õ„Àâ μàÕ¡πÈ”‡À≈◊Õß‚μ°àÕπ⁽⁹⁾ ·μà¢âÕ·π–π”¥—ß°≈à“«°Á¡’¢âÕ‚μâ

·¬âß‡π◊ËÕß®“°°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ ®–¡’

¿“«–·∑√°´âÕπÀ≈—ßºà“μ—¥‰¥â ‡™àπ ¿“«–πÈ”‡À≈◊Õß§—Ëß„μâ

·º≈ºà“μ—¥ (lymphocele) ¿“«–‡π◊ÈÕª“°·º≈ºà“μ—¥‡πà“

μ“¬®“°°“√¢“¥‡≈◊Õ¥¡“‡≈’È¬ß (flap necrosis) ¿“«–

¢“∫«¡®“°°“√§—ËßπÈ”‡À≈◊Õß (lymphedema) ·μà ªí®®ÿ∫—π°Á‰¥â¡’°“√æ—≤π“‡∑§π‘§°“√ºà“μ—¥‡æ◊ËÕ≈¥¿“«–

·∑√°´âÕπ„ÀâπâÕ¬≈ß

°“√¥”‡π‘π‚√§¢Õß¡–‡√ÁßÕß§™“μ‘π—Èπ √Õ¬‚√§®–

‡°‘¥¢÷Èπ∑’Ëμ”·Àπàßª≈“¬Õß§™“μ‘ (glans penis) À√◊Õ„μâ Àπ—ßÀÿâ¡Õ«—¬«–‡æ» (prepuce)^(1,7) ‚¥¬„π√–¬–·√°®–

‡μ‘∫‚μÕ¬à“ß™â“ Ê „π√–¥—∫μ◊Èπ μàÕ¡“‡¡◊ËÕ√Õ¬‚√§≈ÿ°≈“¡≈÷°

≈ß‰ª„πÕß§™“μ‘ °Á®–¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”-

‡À≈◊Õß·≈–Õ«—¬«–Õ◊Ëπ ´÷Ëß∫“ß§√—Èß√Õ¬‚√§¡’¢π“¥‡≈Á° Àπ—ß Àÿâ¡ª≈“¬Õß§™“μ‘‰¡à‡ªî¥ ºŸâªÉ«¬√Ÿâ ÷°Õ—∫Õ“¬ √Ÿâ ÷°°≈—««à“

®–‡ªìπ‚√§√â“¬ §«“¡‰¡à√Ÿâ °“√≈–‡≈¬μàÕ ÿ¢¿“«– °“√

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≈ÿ°≈“¡‰ª¡“° À√◊Õ¡’μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫‚μ·≈â« ´÷Ëß

√–¬–‡«≈“¥—ß°≈à“«Õ“®π“π°«à“ 1 ªïπ—∫·μà‡°‘¥‚√§⁽¹⁰⁾

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À≈—ß°“√ºà“μ—¥Õß§™“μ‘∑—π∑’ À√◊Õ°≈ÿà¡„¥§«√√Õ„Àâμ√«®

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Õ—μ√“°“√√Õ¥™’«‘μ¢ÕßºŸâªÉ«¬∑’Ë¡’ ‚Õ°“ Ÿß∑’Ë®–‡°‘¥°“√

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«‘∏’°“√»÷°…“

‡ªìπ°“√»÷°…“‡™‘ßæ√√≥π“·∫∫¬âÕπÀ≈—ß (retrospective descriptive study) ‚¥¬»÷°…“¢âÕ¡Ÿ≈ºŸâªÉ«¬

∑ÿ°√“¬∑’Ë‰¥â√—∫°“√«‘π‘®©—¬«à“‡ªìπ¡–‡√ÁßÕß§™“μ‘ ·≈–

‡¢â“√—∫°“√√—°…“„π‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™ æ‘…≥ÿ‚≈°

„π™à«ß√–¬–‡«≈“ 11 ªï μ—Èß·μà¡°√“§¡ 2544 ∂÷ß∏—π«“§¡

2554 ®”π«π 102 √“¬ ‚¥¬¥Ÿ®“°∫—π∑÷°‡«™√–‡∫’¬π

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≈”¥—∫§«“¡√ÿπ·√ßæ¬“∏‘«‘∑¬“¢Õß¡–‡√Áß (tumor differentiation) °“√≈ÿ°≈“¡‡©æ“–∑’ËÕß§™“μ‘ (T stage)

∑¥ Õ∫§«“¡πà“‡™◊ËÕ∂◊Õ‚¥¬ Pearsonûs chi-square, Fisherûs exact test, one-way ANOVA, t-test ‚¥¬ p- value < 0.05 ∂◊Õ«à“¡’π—¬ ”§—≠∑“ß ∂‘μ‘ ·≈–∑¥ Õ∫

—¥ à«π§«“¡‡ ’Ë¬ßμàÕ°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß

¥â«¬ Odds ratio (OR) ∑’Ë 95% confidence interval (95% CI) ‚¥¬§à“μË” ÿ¥·≈–§à“ Ÿß ÿ¥¡“°°«à“ 1 ∂◊Õ«à“

¡’π—¬ ”§—≠∑“ß ∂‘μ‘

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μ—Èß·μà‡¥◊Õπ¡°√“§¡ 2544 ∂÷ß ∏—π«“§¡ 2554 √–¬–

‡«≈“√«¡ 11 ªï ¡’ºŸâªÉ«¬‰¥â√—∫°“√«‘π‘®©—¬«à“‡ªìπ¡–‡√Áß Õß§™“μ‘ 102 √“¬ ‚¥¬¡’¢âÕ¡Ÿ≈∫ÿ§§≈¥—ßμ“√“ß∑’Ë 1

ºŸâªÉ«¬ à«π„À≠à¡’¿Ÿ¡‘≈”‡π“Õ¬Ÿà„π®—ßÀ«—¥æ‘…≥ÿ‚≈° 55

√“¬ (53.9%) √Õß≈ß¡“§◊Õ °”·æß‡æ™√ 15 √“¬ (14.7%) Õ—π¥—∫ 3 §◊Õ ‡æ™√∫Ÿ√≥å 10 √“¬ (9.8%) Õ—π¥—∫∂—¥‰ª§◊Õ ÿ‚¢∑—¬ 8 √“¬ (7.8%) æ‘®‘μ√ 7 √“¬ (6.9%) μ“° 5 √“¬

(4.9%) ¥â“πÕ“™’æ¢ÕßºŸâªÉ«¬æ∫«à“ ‰¡à¡’Õ“™’æÀ√◊Õ‰¡à√–∫ÿ 40 √“¬ (39.2%) ‡°…μ√°√√¡ 34 √“¬ (33.3%) ¥â“π ∂“π¿“æ°“√ ¡√ ºŸâªÉ«¬ ¡√ ·≈â« 92 √“¬ (90.2%)

¥â“πÕ“¬ÿ¢ÕßºŸâªÉ«¬ æ∫«à“ ¡—∏¬∞“π 61.50 ªï æ‘ —¬ 27 -

μ“√“ß∑’Ë 1 ¢âÕ¡Ÿ≈ à«π∫ÿ§§≈¢ÕßºŸâªÉ«¬¡–‡√ÁßÕ«—¬«–‡æ»™“¬ ªï æ.». 2544-2554 (n = 102 √“¬)

¢âÕ¡Ÿ≈ à«π∫ÿ§§≈ ®”π«π √âÕ¬≈–

¿Ÿ¡‘≈”‡π“

°”·æß‡æ™√ 15 14.7

μ“° 5 4.9

æ‘®‘μ√ 7 6.9

æ‘…≥ÿ‚≈° 55 53.9

‡æ™√∫Ÿ√≥å 10 9.8

ÿ‚¢∑—¬ 8 7.8

Õ◊Ëπ Ê 2 2.0

Õ“™’æ

‡°…μ√°√√¡ 34 33.3

§â“¢“¬ 1 1.0

π—°∫«™ 2 2.0

√—∫®â“ß 23 22.5

√—∫√“™°“√ 1 1.0

Õ◊Ëπ Ê 1 1.0

‰¡à√–∫ÿ 40 39.2

∂“π¿“æ ¡√

¡√ 92 90.1

‚ ¥ 6 5.9

À¡â“¬ 1 1.0

À¬à“ 1 1.0

‰¡à√–∫ÿ 2 2.0

Õ“¬ÿ

§à“‡©≈’Ë¬ 59.59 ªï, ¡—∏¬∞“π 61.50 ªï, ∞“ππ‘¬¡ 66 ªï à«π‡∫’Ë¬ß‡∫π¡“μ√∞“π 12.92 ªï, æ‘ —¬ 54 ªï, πâÕ¬∑’Ë ÿ¥ 27 ªï, ¡“°∑’Ë ÿ¥ 81 ªï

81 ªï Õ“¬ÿ∑’Ë 25-75 ‡ªÕ√å‡´Áπμå‰∑≈å§◊Õ 48.75-68.50 ªï

®“°μ“√“ß∑’Ë 2 · ¥ß¢âÕ¡Ÿ≈∑“ß§≈‘π‘°¢ÕßºŸâªÉ«¬

‡¡◊ËÕæ‘®“√≥“°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

æ∫«à“¡’ºŸâªÉ«¬ 54 √“¬ (53%) ∑’Ë‰¡à¡’°“√·æ√à°√–®“¬

‰ªμàÕ¡πÈ”‡À≈◊Õßμ≈Õ¥°“√»÷°…“ ·≈–¡’ºŸâªÉ«¬ 48 √“¬

(47%) ∑’Ë¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß ‚¥¬¡’§à“

(4)

À≈—ßºà“μ—¥Õß§™“μ‘®–μâÕßπ—¥μ‘¥μ“¡ºŸâªÉ«¬ ´÷Ëß„π ºŸâªÉ«¬°≈ÿà¡∑’Ë»÷°…“¡’√–¬–‡«≈“°“√μ√«®μ‘¥μ“¡‡©≈’Ë¬

18.48 ‡¥◊Õπ (SD 21.63) πâÕ¬∑’Ë ÿ¥§◊Õ 1 ‡¥◊Õπ π“π

∑’Ë ÿ¥§◊Õ 8 ªï 7 ‡¥◊Õπ “‡Àμÿ∑’ËºŸâªÉ«¬æâπ®“°°“√»÷°…“

¡“°∑’Ë ÿ¥§◊Õ‰¡à¡“μ“¡π—¥ 50 √“¬ (49.0%) ‚¥¬¡’√–¬–

°“√μ√«®μ‘¥μ“¡°àÕπ®–‰¡à¡“μ“¡π—¥‡©≈’Ë¬ 10.56 ‡¥◊Õπ (SD 12.40) ·≈–√–¬–‡«≈“∑’Ëπ“π∑’Ë ÿ¥§◊Õ 4 ªï 4

‡¥◊Õπ°àÕπ‰¡à¡“ ‚¥¬‡ªìπºŸâªÉ«¬∑’Ë‰¡à¡’°“√·æ√à°√–®“¬

‰ªμàÕ¡πÈ”‡À≈◊Õß 30 √“¬ §‘¥‡ªìπ√âÕ¬≈– 60 ¢Õß ºŸâªÉ«¬∑’Ë ‰¡à¡“μ“¡π—¥ ·≈–¡’°“√·æ√à°√–®“¬‰ªμàÕ¡

πÈ”‡À≈◊Õß 20 √“¬§‘¥‡ªìπ√âÕ¬≈– 40 ¢ÕßºŸâªÉ«¬∑’Ë‰¡à¡“

μ“¡π—¥ º≈∑“ßæ¬“∏‘«‘∑¬“¢ÕßºŸâªÉ«¬°≈ÿà¡‰¡à¡“μ“¡π—¥

‡ªìπ carcinoma in situ 1 √“¬ (2%) well differentiated carcinoma 30 √“¬ (60%) moderately differen tiated carcinoma 15 √“¬ (30%) poorly differentiated carcinoma 4 √“¬ (8%) ´÷ËßÕ—μ√“ à«π„°≈â

‡§’¬ß°—∫ºŸâªÉ«¬∑—ÈßÀ¡¥∑’Ë»÷°…“ ·¡â«à“ºŸâªÉ«¬∫“ß√“¬®–

‡§¬¢“¥π—¥μ√«®μ‘¥μ“¡‰ª°àÕπÀπâ“®–¡’¿“«–μàÕ¡πÈ”-

‡À≈◊Õß¢“Àπ’∫‚μ ·μà‡¡◊ËÕ‡°‘¥¿“«–¥—ß°≈à“«¢÷Èπ ºŸâªÉ«¬

°Á®–∂Ÿ° àß°≈—∫¡“√—°…“¬—ß‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™

‡π◊ËÕß®“° ∂“πæ¬“∫“≈Õ◊Ëπ¬—ß‰¡à¡’·æ∑¬å‡©æ“–∑“ß ‘Èπ ÿ¥°“√»÷°…“‚¥¬∑’ËºŸâªÉ«¬¬—ß§ß¡“μ√«®μ‘¥μ“¡Õ¬Ÿà 31 √“¬ (30.4%) ºŸâªÉ«¬√–¬– ÿ¥∑â“¬ (end stage) ∂Ÿ°

àß‰ª√—°…“·∫∫ª√–§—∫ª√–§Õß¬—ß‚√ßæ¬“∫“≈„°≈â∫â“π 15 √“¬ (14.7%) ‡ ’¬™’«‘μ„π‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™ 6

√“¬ (5.9%) ‚¥¬∑’Ë 2 √“¬‡ ’¬™’«‘μ®“°¡–‡√ÁßÕß§™“μ‘

∑’Ë‡À≈◊Õ‡ ’¬™’«‘μ®“°‚√§Õ◊Ëπ Ê

®“°μ“√“ß∑’Ë 3 §«“¡ —¡æ—π∏å√–À«à“ßÕ“¬ÿ·≈–º≈

∑“ßæ¬“∏‘«‘∑¬“¢Õß¡–‡√ÁßÕß§™“μ‘ æ∫«à“Õ“¬ÿ‡©≈’Ë¬¢Õß ºŸâªÉ«¬∑’Ëº≈∑“ßæ¬“∏‘«‘∑¬“‡ªìπ carcinoma in situ §◊Õ 66.50 ªï °≈ÿà¡∑’Ëº≈‡ªìπ well differentiated carcinoma

§◊Õ 59.60 ªï °≈ÿà¡∑’Ëº≈‡ªìπ moderately differentiated carcinoma §◊Õ 57.98 ªï °≈ÿà¡∑’Ëº≈‡ªìπpoorly differentiated carcinoma §◊Õ 66.71 ªï ‡¡◊ËÕ∑¥ Õ∫§à“‡©≈’Ë¬

¢ÕßÕ“¬ÿ·μà≈–°≈ÿà¡¥â«¬ one-way ANOVA æ∫«à“‰¡à¡’

μ“√“ß∑’Ë 2 ¢âÕ¡Ÿ≈∑“ß§≈‘π‘°¢ÕßºŸâªÉ«¬¡–‡√ÁßÕ«—¬«–‡æ»™“¬ ªï æ.».

2544-2554 (n = 102 √“¬)

¢âÕ¡Ÿ≈∑“ß§≈‘π‘° ®”π«π √âÕ¬≈–

Õ“°“√ ”§—≠

μ‘¥‡™◊ÈÕª≈“¬Õ«—¬«–‡æ» 11 10.8

°âÕπ‡π◊ÈÕßÕ° 47 46.1

·º≈ 44 43.1

°“√ºà“μ—¥

Partial penectomy 69 67.6

Total penectomy 27 26.5

Wide excision 6 5.9

º≈æ¬“∏‘«‘∑¬“¢Õß¡–‡√Áß

Carcinoma in situ 2 2

Well differentiated 53 52

Moderately differentiated 40 39.1

Poorly differentiated 7 6.9

æ¬“∏‘ ¿“æμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

‰¡à¡’¿“«–μàÕ¡πÈ”‡À≈◊Õß‚μ 54 53

μàÕ¡πÈ”‡À≈◊Õß‚μ·√°√—∫ 18 17.6

¡’μàÕ¡πÈ”‡À≈◊Õß‚μÀ≈—ßºà“μ—¥Õß§™“μ‘ 30 29.4

¡–‡√Áß≈ÿ°≈“¡ Corpus Cavernosum

‰¡à¡’ 69 67.6

¡’ 33 32.4

¡–‡√Áß≈ÿ°≈“¡ Urethra

‰¡à¡’ 83 81.4

¡’ 19 18.6

°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

‰¡à¡’ 69 67.6

¡’ 33 32.4

‡©≈’Ë¬√–¬–‡«≈“∑’Ë°√–®“¬‰ª 3.56 ‡¥◊Õπ (SD 4.237) §à“

πâÕ¬∑’Ë ÿ¥§◊Õ 0 ‡¥◊Õπ ´÷ËßÀ¡“¬∂÷ßμàÕ¡πÈ”‡À≈◊Õß‚μ‡¡◊ËÕ

·√°√—∫ ·≈–π“π∑’Ë ÿ¥§◊Õ 15 ‡¥◊Õπ ·μà‡¡◊ËÕμ—¥ºŸâªÉ«¬

∑’Ë¡’μàÕ¡πÈ”‡À≈◊Õß‚μ·√°√—∫ÕÕ° æ∫«à“ºŸâªÉ«¬ 30 √“¬

(29.4%) ∑’ËμàÕ¡πÈ”‡À≈◊Õß‚μÀ≈—ßºà“μ—¥Õß§™“μ‘ ®–¡’

√–¬–‡«≈“‡©≈’Ë¬ 5.70 ‡¥◊Õπ (SD 4.061)

(5)

«“√ “√«‘™“°“√ “∏“√≥ ÿ¢ Úıı ˆ ªï∑’Ë ÚÚ ©∫—∫∑’Ë Ú

Ú¯Ò

§«“¡·μ°μà“ß°—π (p 0.348)

®“°μ“√“ß∑’Ë 4 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–Õ“¬ÿ¢ÕßºŸâªÉ«¬

æ∫«à“°≈ÿà¡∑’Ë¡’°“√·æ√à°√–®“¬‚¥¬√«¡∑—Èß°√≥’∑’Ë¡’°“√

·æ√à°√–®“¬·≈â«‡¡◊ËÕ·√°√—∫·≈–¿“¬À≈—ßºà“μ—¥Õß§™“μ‘

®”π«π 48 √“¬ ¡’Õ“¬ÿ‡©≈’Ë¬ 57.04 ªï (SD 12.50) à«π

°≈ÿà¡∑’Ë‰¡à¡’°“√·æ√à°√–®“¬ 54 √“¬¡’Õ“¬ÿ‡©≈’Ë¬ 61.85 ªï (SD 12.98) ‡¡◊ËÕ∑¥ Õ∫¥â«¬ t-test æ∫«à“‰¡à¡’§«“¡

·μ°μà“ß√–À«à“ßÕ“¬ÿºŸâªÉ«¬∑—Èß Õß°≈ÿà¡ (p 0.060)

®“°μ“√“ß∑’Ë 5 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–º≈∑“ßæ¬“∏‘«‘∑¬“

æ∫«à“ºŸâªÉ«¬∑’Ë¡’º≈∑“ßæ¬“∏‘«‘∑¬“‡ªìπ well differentiated carcinoma 53 √“¬ ®–¡’°“√·æ√à°√–®“¬‰ª μàÕ¡πÈ”‡À≈◊Õß 16 √“¬ (30.2%) ‰¡à¡’°“√·æ√à°√–®“¬

37 √“¬ (69.8%) ºŸâªÉ«¬∑’Ë¡’º≈∑“ßæ¬“∏‘«‘∑¬“‡ªìπ moderately differentiated carcinoma 40 √“¬ ®–¡’°“√

·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß 26 √“¬ (65%) ‰¡à¡’°“√

·æ√à°√–®“¬ 14 √“¬ (35%) ºŸâªÉ«¬∑’Ë¡’º≈∑“ßæ¬“∏‘

«‘∑¬“‡ªìπ poorly differentiated carcinoma 7 √“¬

®–¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß 6 √“¬ (85.7%)

‰¡à¡’°“√·æ√à°√–®“¬ 1 √“¬ (14.3%) à«π carcinoma in situ ®”π«π 2 √“¬ ‰¡à¡’°“√·æ√à°√–®“¬‰ªμàÕ¡

πÈ”‡À≈◊Õß ‡π◊ËÕß®“°‡ªìπ¡–‡√Áß∑’Ë¡’§«“¡√ÿπ·√ßμË” ‡¡◊ËÕ

∑¥ Õ∫¥â«¬ Fisherûs exact test æ∫«à“¡’§«“¡·μ°- μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p < 0.001) ·≈–‡¡◊ËÕ

‡ª√’¬∫‡∑’¬∫§«“¡‡ ’Ë¬ßμàÕ°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”-

‡À≈◊Õß®“°§à“ OR ‚¥¬‡ª√’¬∫‡∑’¬∫°—∫ºŸâªÉ«¬°≈ÿà¡∑’Ë¡’º≈

∑“ßæ¬“∏‘«‘∑¬“‡ªìπ well differentiated carcinoma æ∫«à“ºŸâªÉ«¬°≈ÿà¡∑’Ë¡’º≈∑“ßæ¬“∏‘«‘∑¬“‡ªìπ moderately differentiated carcinoma ®–¡’§à“ OR 4.299 (95%

CI 1.790, 10.305) ·≈–ºŸâªÉ«¬°≈ÿà¡∑’Ë¡’º≈∑“ßæ¬“∏‘

«‘∑¬“‡ªìπ poorly differentiated carcinoma ®–¡’§à“

μ“√“ß∑’Ë 3 §«“¡ —¡æ—π∏å¢ÕßÕ“¬ÿ·≈–º≈æ¬“∏‘«‘∑¬“¢Õß¡–‡√ÁßÕß§™“μ‘ (n=102 √“¬)

º≈∑“ßæ¬“∏‘«‘∑¬“ ®”π«πºŸâªÉ«¬ (√“¬) Õ“¬ÿ‡©≈’Ë¬ (ªï) à«π‡∫’Ë¬ß‡∫π¡“μ√∞“π (ªï) p-value

Carcinoma in situ 2 66.50 0.71 0.348*

Well differentiated 53 59.60 13.60

Moderately differentiated 40 57.98 12.16

Poorly differentiated 7 66.71 12.38

Total 102 59.59 12.92

*∑¥ Õ∫¥â«¬ one-way ANOVA

μ“√“ß∑’Ë 4 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–Õ“¬ÿ¢ÕßºŸâªÉ«¬¡–‡√ÁßÕß§™“μ‘ (n=102 √“¬)

°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

p-value

¡’°“√·æ√à°√–®“¬^† ‰¡à¡’°“√·æ√à°√–®“¬

§à“‡©≈’Ë¬Õ“¬ÿ (ªï) 57.04 61.85 0.060*

®”π«π 48 54

à«π‡∫’Ë¬ß‡∫π¡“μ√∞“π (ªï) 12.50 12.98

*∑¥ Õ∫¥â«¬ t-test

†√«¡ºŸâªÉ«¬∑’Ë¡’°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫∑—Èß‡¡◊ËÕ·√°√—∫·≈–À≈—ß°“√ºà“μ—¥Õß§™“μ‘

(6)

OR 13.889 (95% CI 1.542, 124.813) ´÷Ëß¡’π—¬ ”§—≠

∑“ß ∂‘μ‘

®“°μ“√“ß∑’Ë 6 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß·≈–°“√≈ÿ°≈“¡‡©æ“–∑’ËÕß§™“μ‘

æ∫«à“°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫‰¡à ¡’

§«“¡ —¡æ—π∏å°—∫°“√∑’Ë¡–‡√Áß≈ÿ°≈“¡‡¢â“ Ÿà corpus carvernosum (p 0.203) ‡™àπ‡¥’¬«°—∫°“√≈ÿ°≈“¡‡¢â“ Ÿà urethra °Á‰¡à¡’§«“¡ —¡æ—π∏å°—∫°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”-

‡À≈◊Õß‡™àπ°—π (p 0.976) ‡¡◊ËÕ∑¥ Õ∫∑—Èß Õß°√≥’¥â«¬

Pearsonûs chi-square ·≈–‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫§«“¡

‡ ’Ë¬ßμàÕ°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß®“°§à“ OR

°≈ÿà¡∑’Ë¡–‡√Áß≈ÿ°≈“¡‡¢â“ Ÿà corpus carvernosum ‡¡◊ËÕ

‡∑’¬∫°—∫°≈ÿà¡∑’Ë‰¡à¡’ ®–¡’§à“ OR 1.872 (95% CI 0.808, 4.335) à«π°≈ÿà¡∑’Ë¡–‡√Áß≈ÿ°≈“¡‡¢â“ Ÿà urethra ‡¡◊ËÕ

‡∑’¬∫°—∫°≈ÿà¡∑’Ë‰¡à¡’ ®–¡’§à“ OR 1.016 (95% CI 0.374, 2.756) ´÷Ëß‰¡à¡’π—¬ ”§—≠∑“ß ∂‘μ‘

®“°√“¬ß“πº≈°“√μ√«®∑“ßæ¬“∏‘«‘∑¬“¡’°“√

√–∫ÿ∂÷ß°“√æ∫ tumor emboli „π∑àÕ∑“ß‡¥‘ππÈ”‡À≈◊Õß (lymphatic embolization) 7 √“¬ ∑ÿ°√“¬¡’°“√·æ√à

°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ ·≈–æ∫ tumor em-

μ“√“ß∑’Ë 5 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–º≈æ¬“∏‘«‘∑¬“¢Õß¡–‡√ÁßÕß§™“μ‘ (n=102 √“¬)

°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

º≈∑“ßæ¬“∏‘«‘∑¬“ ¡’°“√·æ√à ‰¡à¡’°“√·æ√à √«¡ Odds Odds ratio 95% CI p-value

°√–®“¬ (%)^† °√–®“¬ (%) Lower Upper

Carcinoma in situ 0 (0) 2 (100) 2 0 0 - - < 0.001*

Well differentiated 16 (30.2) 37 (69.8) 53 0.432 1 - -

Moderately differentiated 26 (65) 14 (35) 40 1.857 4.299 1.790 10.305

Poorly differentiated 6 (85.7) 1 (14.3) 7 6 13.889 1.542 124.813

√«¡ 48 (47.1) 54 (52.9) 102

*∑¥ Õ∫¥â«¬ Fisherûs exact test

μ“√“ß∑’Ë 6 §«“¡ —¡æ—π∏å√–À«à“ß°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–°“√≈ÿ°≈“¡‡©æ“–∑’ËÕß§™“μ‘ (n=102 √“¬)

°“√·æ√à°√–®“¬¡“¬—ßμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

°“√≈ÿ°≈“¡‡©æ“–∑’ËÕß§™“μ‘ ¡’°“√·æ√à ‰¡à¡’°“√·æ√à √«¡ Odds Odds ratio 95% CI p-value

°√–®“¬ (%)^† °√–®“¬ (%) Lower Upper

≈ÿ°≈“¡‡¢â“ Ÿà Corpus Carvernosum

‰¡à¡’ 29 (42) 40 (58) 69 0.725 1 - - 0.203*

¡’ 19 (57.6) 14 (42.4) 33 1.357 1.872 0.808 4.335

≈ÿ°≈“¡‡¢â“ Ÿà Urethra

‰¡à¡’ 39 (47) 44 (53) 83 0.886 1 - - 0.976*

¡’ 9 (47.4) 10 (52.6) 19 0.9 1.016 0.374 2.756

*∑¥ Õ∫¥â«¬ Pearsonûs chi-square

(7)

«“√ “√«‘™“°“√ “∏“√≥ ÿ¢ Úıı ˆ ªï∑’Ë ÚÚ ©∫—∫∑’Ë Ú

Ú¯Û

boli „πÀ≈Õ¥‡≈◊Õ¥¥” (venous embolization) 5 √“¬

∑ÿ°√“¬¡’ lymphatic embolization ·≈–¡’°“√·æ√à

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®“°°“√»÷°…“ºŸâªÉ«¬¡–‡√ÁßÕß§™“μ‘®”π«π 102 √“¬

„π‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™ æ∫«à“ºŸâªÉ«¬√âÕ¬≈– 53.9 Õ ¬Ÿà„π®—ßÀ«—¥æ‘…≥ÿ‚≈° à«π∑’Ë‡À≈◊Õ‡¥‘π∑“ß¡“®“°

®—ßÀ«—¥¢â“ß‡§’¬ß∑’Ë‰¡à¡’»—≈¬·æ∑¬å√–∫∫∑“ß‡¥‘πªí “«–

´÷Ëß∫“ß®—ßÀ«—¥¡’√–¬–∑“ß¡“°°«à“ 100 °‘‚≈‡¡μ√ ∑”„Àâ

¡’§à“„™â®à“¬ Ÿß „π¢≥–∑’ËºŸâªÉ«¬ à«π„À≠à‰¡à¡’Õ“™’æ ∑”

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„°≈â‡§’¬ß°—∫º≈°“√»÷°…“¢Õß Mc Dougal WS⁽⁸⁾ ´÷Ëß

‰¥â§à“Õ“¬ÿ‡©≈’Ë¬ 61 SD 15 ªï

¡–‡√ÁßÕß§™“μ‘‡ªìπ¡–‡√Áß∑’Ë¡’°“√≈ÿ°≈“¡‡©æ“–∑’Ë

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°Á®–¡’ ∂“π–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫‚μμ—Èß·μà·√°√—∫ ´÷Ëß

„π°“√»÷°…“π’È®–æ‘®“√≥“ºŸâªÉ«¬∑’Ë¡’μàÕ¡πÈ”‡À≈◊Õß‚μ

·√°√—∫·≈–ºŸâªÉ«¬∑’Ë¡’μàÕ¡πÈ”‡À≈◊Õß‚μÀ≈—ß°“√ºà“μ—¥

Õß§™“μ‘‡ªìπºŸâªÉ«¬°≈ÿà¡‡¥’¬«°—π ‚¥¬æ∫«à“¡’ºŸâªÉ«¬√âÕ¬≈–

47.1 ∑’Ë¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ ‚¥¬

¡’√–¬–‡«≈“‡©≈’Ë¬§◊Õ 3.56 ‡¥◊Õπ ·μàÀ“°μ—¥°≈ÿà¡ºŸâªÉ«¬

∑’Ë¡’¿“«–μàÕ¡πÈ”‡À≈◊Õß‚μμ—Èß·μà·√°√—∫ÕÕ° §à“‡©≈’Ë¬

∑’Ë¡–‡√Áß®–·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊ÕßÀ≈—ßºà“μ—¥

Õß§™“μ‘§◊Õ 5.70 ‡¥◊Õπ ∑’Ëπà“ π„®§◊Õ√–¬–‡«≈“∑’Ëπ“π

∑’Ë ÿ¥∑’Ëæ∫¡–‡√Áß·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫§◊Õ 15 ‡¥◊Õπ ¥—ßπ—ÈπÀ“°¡’°“√μ√«®μ‘¥μ“¡ºŸâªÉ«¬π“π‡°‘π°«à“

15 ‡¥◊Õπ·≈â«ºŸâªÉ«¬¬—ß§ß‰¡à¡’¿“«–º‘¥ª√°μ‘ ®–∂◊Õ«à“

ºŸâªÉ«¬‡À≈à“π—ÈπÀ“¬¥’·≈â«‰¡àμâÕßπ—¥¡“μ√«®μ‘¥μ“¡Õ’°

‰¥âÀ√◊Õ‰¡à ´÷Ëß Õ¥§≈âÕß°—∫ Lubke WL. et al.⁽⁹⁾ ‰¥â

· ¥ß§«“¡‡ÀÁπ«à“ À“°¡–‡√ÁßÕß§™“μ‘®–¡’°“√‡ªìπ

°≈—∫´È”®–‡°‘¥„π 2 ªï

ºŸâªÉ«¬ à«π¡“°®–‰¥â√—∫°“√ºà“μ—¥¡–‡√ÁßÕß§™“μ‘

¥â«¬«‘∏’ partial penectomy 69 √“¬ (67.6%) total penectomy 27 √“¬ (26.5%) ·≈–¡’ºŸâªÉ«¬‰¥â√—∫°“√

ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ 33 √“¬ (32.4%) ´÷Ëß ºŸâªÉ«¬°≈ÿà¡π’È®–‰¥â√—∫°“√√—°…“‡æ‘Ë¡‡μ‘¡®“°Õ“¬ÿ√·æ∑¬å

‚√§¡–‡√Áß·≈–√—ß ’·æ∑¬å ·μà°Á¡’ºŸâªÉ«¬∫“ß√“¬∑’Ë·æ∑¬å ºŸâ√—°…“æ‘®“√≥“«à“ ¡§«√‰¥â√—∫°“√§«∫§ÿ¡°“√·æ√à

°√–®“¬¥â«¬°“√„™â√—ß ’√—°…“ ‚¥¬‰¡àºà“μ—¥‡≈“–μàÕ¡πÈ”-

‡À≈◊Õß°àÕπ Õ¬à“ß‰√°Áμ“¡ ‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™‡æ‘Ëß

‡ªî¥„Àâ∫√‘°“√§≈‘π‘°‚√§¡–‡√Áß‡¡◊ËÕ ¡°√“§¡ 2550 ‚¥¬

àß‰ª√—∫√—ß ’√—°…“∑’Ë ‚√ßæ¬“∫“≈‡Õ°™π ´÷Ëß„Àâ∫√‘°“√

‡©æ“–ºŸâªÉ«¬„π‚§√ß°“√À≈—°ª√–°—π ÿ¢¿“æ∑’Ë¢÷Èπ

∑–‡∫’¬π°—∫∑“ß‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™‡∑à“π—Èπ ·≈–

‡ªî¥„Àâ∫√‘°“√‡μÁ¡√Ÿª·∫∫·°àºŸâªÉ«¬∑ÿ°√“¬„π‚√ßæ¬“∫“≈

æÿ∑∏™‘π√“™„πªïæ.». 2553 ‚¥¬°àÕπÀπâ“π’ÈºŸâªÉ«¬∑’ËμâÕß

‰¥â√—∫√—ß ’√—°…“ μâÕß àß‰ª√—∫°“√√—°…“∑’Ë ∂“∫—π¡–‡√Áß

·Ààß™“μ‘ “¢“≈æ∫ÿ√’À√◊Õ≈”ª“ß ´÷Ëß‡¡◊ËÕ àßºŸâªÉ«¬‰ª·≈â«

°Á®–μ‘¥μ“¡ºŸâªÉ«¬‰¥â≈”∫“°‡π◊ËÕß®“°√–¬–∑“ß·≈–°“√

◊ËÕ “√ πÕ°®“°∑“ß ∂“∫—π¡–‡√Áß·Ààß™“μ‘ àßºŸâªÉ«¬

°≈—∫¡“‡æ◊ËÕμ√«®μ‘¥μ“¡À≈—ß„Àâ°“√√—°…“ ‚¥¬ºŸâªÉ«¬¡“

μ√«®μ‘¥μ“¡μàÕ‡π◊ËÕß¡’§à“‡©≈’Ë¬ 18.48 ‡¥◊Õπ (SD 21.63) “‡Àμÿ∑’Ë ‘Èπ ÿ¥°“√μ√«®μ‘¥μ“¡¡“°∑’Ë ÿ¥§◊Õ‰¡à¡“μ“¡π—¥

(49%) ‚¥¬¡’√–¬–‡«≈“°“√μ√«®μ‘¥μ“¡°àÕπ®–‰¡à¡“

μ“¡π—¥‡©≈’Ë¬ 10.56 ‡¥◊Õπ (SD 12.40) ·≈–π“π∑’Ë ÿ¥

(8)

§◊Õ 4 ªï 4 ‡¥◊Õπ°àÕπ‰¡à¡“ ‡Àμÿ∑’ËºŸâªÉ«¬‰¡à¡“μ√«®

μ‘¥μ“¡‡æ√“–ºŸâ«‘®—¬§“¥«à“ºŸâªÉ«¬§‘¥«à“μπ‡ÕßÀ“¬‡ªìπ ª√°μ‘¥’·≈â« ª√–°Õ∫°—∫§«“¡‰¡à –¥«°„π°“√‡¥‘π∑“ß

®÷ß‰¡à‡ÀÁπ§«“¡®”‡ªìπ„π°“√¡“æ∫·æ∑¬åÕ’° ·≈–°“√

»÷°…“π’È‡°Á∫¢âÕ¡Ÿ≈¬âÕπÀ≈—ß‡ªìπ‡«≈“π“π 11 ªï ª√–°Õ∫

°—∫ºŸâªÉ«¬ à«π„À≠à¡’Õ“¬ÿ¡“°·≈–Õ¬Ÿàμà“ß®—ßÀ«—¥ À“°

ºŸâªÉ«¬μâÕß‡¢â“√—°…“æ¬“∫“≈À√◊Õ‡ ’¬™’«‘μ®“°‚√§„¥ Ê

„π‚√ßæ¬“∫“≈ª√–®”Õ”‡¿ÕÀ√◊Õ®—ßÀ«—¥¢Õßμπ °Á®–

°≈“¬‡ªìπºŸâªÉ«¬∑’Ë‰¡à¡“μ√«®μ‘¥μ“¡¢Õß‚√ßæ¬“∫“≈

æÿ∑∏™‘π√“™ ´÷ËßμâÕß¡’°“√»÷°…“«‘®—¬‡æ‘Ë¡‡μ‘¡·≈–

«“ß·ºπμ‘¥μ“¡ºŸâªÉ«¬„Àâ¥’¬‘Ëß¢÷ÈπμàÕ‰ª

°“√»÷°…“º≈æ¬“∏‘«‘∑¬“¢Õß¡–‡√ÁßÕß§™“μ‘æ∫«à“

ºŸâªÉ«¬ à«π¡“°‡ªìπ™π‘¥ well differentiated carcinoma 53 √“¬ (52%) ‡ªìπ™π‘¥ moderately differentiated carcinoma 40 √“¬ (39.1%) ·≈– poorly differentiated carcinoma 7 √“¬ (6.9%) à«π carcinoma in situ ´÷Ëß‡ªìπ¡–‡√Áß∑’Ë¡’§«“¡√ÿπ·√ßπâÕ¬·≈–‰¡àæ∫°“√

·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¡’ 2 √“¬ (2%) ·≈–‡¡◊ËÕ

»÷°…“§«“¡ —¡æ—π∏å¢Õßº≈∑“ßæ¬“∏‘«‘∑¬“°—∫Õ“¬ÿ¢Õß ºŸâªÉ«¬ æ∫«à“‰¡à¡’§«“¡ —¡æ—π∏å°—π (p 0.348) ¥—ßπ—Èπ ºŸâªÉ«¬∑ÿ°™à«ßÕ“¬ÿ ®÷ß¡’ ‚Õ°“ ‡°‘¥¡–‡√ÁßÕß§™“μ‘∑’Ë¡’

§«“¡√ÿπ·√ß∑“ßæ¬“∏‘«‘∑¬“™π‘¥μà“ß Ê ‰¥â ‰¡à·μ°μà“ß°—π ªí®®—¬ ”§—≠∑’Ë¡’º≈μàÕ°“√æ¬“°√≥å‚√§„πºŸâªÉ«¬

¡–‡√ÁßÕß§™“μ‘ §◊Õ°“√μ√«®æ∫°“√·æ√à°√–®“¬‰ª μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫ ºŸâªÉ«¬∑’Ë‰¡à¡’°“√·æ√à°√–®“¬‰ª μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫®–¡’°“√√Õ¥™’«‘μ 5 ªï√âÕ¬≈–

71-95 „π¢≥–∑’ËºŸâªÉ«¬∑’Ë¡’°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”-

‡À≈◊Õß¢“Àπ’∫ ®–¡’°“√√Õ¥™’«‘μ 5 ªï‡æ’¬ß√âÕ¬≈– 28

¥—ßπ—Èπ°“√À“ªí®®—¬∑’Ë®–∑”π“¬°“√·æ√à°√–®“¬‰ªμàÕ¡

πÈ”‡À≈◊Õß¢“Àπ’∫®÷ß¡’§«“¡ ”§—≠ ∑—Èßπ’È‡æ◊ËÕ‡ªìπ°“√

À≈’°‡≈’Ë¬ß¿“«–·∑√°´âÕπÕ—π‡°‘¥®“°°“√ºà“μ—¥‡≈“–

μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫„πºŸâªÉ«¬∑’Ë‰¡àπà“®–‰¥â√—∫ª√–‚¬™πå

®“°°“√ºà“μ—¥ ·≈–™à«¬μ—¥ ‘π„®ºà“μ—¥„π√“¬∑’Ëπà“®–‰¥â

√—∫ª√–‚¬™πå °àÕπ∑’Ë®–¡’°“√·æ√à°√–®“¬·≈–¡’μàÕ¡πÈ”-

‡À≈◊Õß‚μÕ¬à“ß™—¥‡®π ∑—Èßπ’È‡æ◊ËÕ‡æ‘Ë¡‚Õ°“ √Õ¥™’«‘μ¢Õß

ºŸâªÉ«¬„π°≈ÿà¡∑’Ëπà“®–‰¥â√—∫ª√–‚¬™πå⁽¹¹⁾ ‚¥¬ªí®®—¬∑’ËÕ“®

∫àß™’È ‚Õ°“ ∑’Ë®–‡°‘¥°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß

¢“Àπ’∫‰¥â·°à ≈”¥—∫§«“¡√ÿπ·√ß∑“ßæ¬“∏‘«‘∑¬“¢Õß

¡–‡√Áß (tumor differentiation) °“√≈ÿ°≈“¡¢Õß¡–‡√Áß

‡¢â“ Ÿà corpus carvernosum À√◊Õ urethra (T stage)

·≈–°“√æ∫ tumor emboli „π∑àÕ∑“ß‡¥‘ππÈ”‡À≈◊Õß

·≈–À≈Õ¥‡≈◊Õ¥¥”®“°°“√Õà“πº≈∑“ßæ¬“∏‘«‘∑¬“^(9,11-13)

®“°μ“√“ß∑’Ë 4 ‡¡◊ËÕ»÷°…“∂÷ß§«“¡ —¡æ—π∏å√–À«à“ß

°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫·≈–Õ“¬ÿ¢Õß ºŸâªÉ«¬ æ∫«à“Õ“¬ÿ‡©≈’Ë¬¢ÕßºŸâªÉ«¬∑’Ë¡’°“√·æ√à°√–®“¬‰ª μàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫§◊Õ 57.04 ªï ·≈–ºŸâªÉ«¬∑’Ë‰¡à¡’°“√

·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß§◊Õ 61.85 ªï ·μà‰¡à·μ°

μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p 0.060) ®÷ß √ÿª‰¥â

«à“Õ“¬ÿ‰¡à¡’§«“¡ —¡æ—π∏å°—∫°“√·æ√à°√–®“¬‰ªμàÕ¡

πÈ”‡À≈◊Õß¢“Àπ’∫

®“°μ“√“ß∑’Ë 5 º≈°“√»÷°…“ºŸâªÉ«¬¡–‡√ÁßÕß§™“μ‘

„π‚√ßæ¬“∫“≈æÿ∑∏™‘π√“™ æ∫«à“º≈∑“ßæ¬“∏‘«‘∑¬“¡’

§«“¡ —¡æ—π∏å°—∫°“√·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß¢“Àπ’∫

‚¥¬ºŸâªÉ«¬∑’Ë√—∫°“√ºà“μ—¥Õß§™“μ‘∑’Ë¡’º≈æ¬“∏‘«‘∑¬“‡ªìπ well differentiated carcinoma 53 √“¬ ®–¡’°“√·æ√à

°√–®“¬‡æ’¬ß 16 √“¬ (30.19%) μà“ß°—∫°≈ÿà¡∑’Ëº≈

æ¬“∏‘«‘∑¬“‡ªìπ moderately differentiated carcinoma 40 √“¬ ®–¡’°“√·æ√à°√–®“¬ 26 √“¬ (65%) ·≈–

°≈ÿà¡∑’Ë¡’º≈∑“ßæ¬“∏‘«‘∑¬“‡ªìπ poorly differentiated carcinoma 7 √“¬ ®–¡’°“√·æ√à°√–®“¬ 6 √“¬ (85%)

®÷ß √ÿª‰¥â«à“º≈∑“ßæ¬“∏‘«‘∑¬“¢Õß¡–‡√ÁßÕß§™“μ‘¡’

(p < 0.001)^(2,12) ·≈–‡¡◊ËÕæ‘®“√≥“§«“¡‡ ’Ë¬ßμàÕ°“√

·æ√à°√–®“¬‰ªμàÕ¡πÈ”‡À≈◊Õß®“°§à“ OR ºŸâªÉ«¬°≈ÿà¡

moderately differentiated carcinoma ®–¡’ OR 4.299 (95% CI 1.790, 10.305) ·≈–ºŸâªÉ«¬°≈ÿà¡ poorly differentiated carcinoma ®–¡’ OR 13.889 (95% CI 1.542, 124.813) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ºŸâªÉ«¬°≈ÿà¡ well differentiated carcinoma μ“¡≈”¥—∫ ¥—ßπ—ÈπÀ“°º≈

∑“ßæ¬“∏‘«‘∑¬“¢Õß¡–‡√Áß‡ªìπ™π‘¥ well differentiated

(9)

Ú¯ı

carcinoma °Á§«√®–„™â«‘∏’°“√μ√«®μ‘¥μ“¡ºŸâªÉ«¬∑ÿ° 3

‡¥◊Õπ À“°æ∫«à“§≈”‰¥âμàÕ¡πÈ”‡À≈◊Õß‚μ¢÷Èπ ®÷ß®–

∑”°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊ÕßÕÕ° ‡æ◊ËÕ≈¥°“√ºà“μ—¥

∑’Ë‰¡à®”‡ªìπÕ—π®–¡’º≈∑”„Àâ‡°‘¥¿“«–·∑√°´âÕπ¢Õß°“√

ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊Õß ·μàÀ“°º≈æ¬“∏‘«‘∑¬“¢Õß

¡–‡√Áß‡ªìπ moderately differentiated carcinoma À√◊Õ poorly differentiated carcinoma °Áπà“®–·π–π”„Àâ

∑”°“√ºà“μ—¥‡≈“–μàÕ¡πÈ”‡À≈◊ÕßÕÕ°‰¥â‡≈¬ ‚¥¬‰¡àμâÕß

√Õ„ÀâμàÕ¡πÈ”‡À≈◊Õß‚μ°àÕπ ‡π◊ËÕß®“°°“√ºà“μ—¥°àÕπ∑’Ë μàÕ¡πÈ”‡À≈◊Õß®–‚μ®–∑”‰¥âßà“¬°«à“ ·≈–‡æ‘Ë¡‚Õ°“

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6.

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‡Õ° “√Õâ“ßÕ‘ß

1. ÿ√‘∏√ ÿπ∑√æ—π∏å. ¡–‡√ÁßÕß§™“μ‘. „π: «™‘√ §™°“√,

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Ú¯˜

primary lymphadenectomy. J Urol 1986; 136(1):38- 41.

15. Edge SB, Byrd DR, Campton CC, Fritz AG, Greene

Abstract Penile Cancer in Bhuddhachinaraj Hospital : Analysis of Prognostic Factors for Inguinal Node Metastasis

Pongsak Sancharoen

Department of Surgery, Bhuddhachinaraj Phitsanulok Hospital Journal of Health Science 2013; 22:277-287.

Penile cancer is an uncommon disease. This retrospective descriptive study reported 102 patients who had penile cancer treated at Bhuddhachinaraj Phitsanulok Hospital from January 2001 to December 2011. The average age was 59.59 years. Most of clinical presentation included exophytic growth and ulcer. The surgical management for penile lesion included partial penectomy in 67.6 percent and total penectomy in 26.5 percent. The histological differentiation of tumor included well differentiated carcinoma in 52 percent, moderately differentiated carcinoma in 39.2 percent and poorly differentiated carcinoma in 6.9 percent. The patients had no clinical groin node metastasis in 52.9 percent and had groin node metastasis in 47.1 percent with average time after penile amputation was 3.56 months and the longest time in case of groin node metastasis after amputation was 15 months. The main factors affecting significantly the incidence of groin node metastasis was degree of tumor differentiation but age and T stage were not. Lymphatic and venous embolization were most likely suggestive factors affecting incidence of groin node metastasis. The patients who had significant incidence should undergo immediate inguinal lymphadenectomy.

Key words: penile cancer, groin node metastasis, inguinal lymphadenectomy

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