42例原发性阴道恶性肿瘤临床分析

目的 总结原发性阴道恶性肿瘤的l临床特点,探讨原发性阴道恶性肿瘤的治疗方法 及预后因素.方法 同顾性分析1984年1月-2006年8月北京协和医院收治的42例原发性阴道恶性肿瘤患者的临床特点、治疗方法 及预后情况.结果 原发性阴道恶性肿瘤患者占本院同期收治妇科恶性肿瘤患者的0.98%(42/4286).42例患者中,鳞癌13例,黑色素瘤13例,腺癌8例,内胚窦瘤及肉瘤各3例,癌肉瘤及阴道上皮瘤样癌各1例;1期19例,Ⅱ期12例,Ⅲ期5例,Ⅳ期6例.治疗七采用了以手术为主的综合治疗.随诊至2007年8月,有19例患者牛存,死亡18例,失访5例.随诊时间最长为10年,中位随诊时间为2年,总体两年生存率达60.6%.其中,1期患者的两年生存率为71.3%,Ⅱ期为58.3%,Ⅲ～Ⅵ期为29.6%.根据病理类型不同,鳞癌患者的两年生存率为46.8%,黑色素瘤为72.9%,腺癌为20.0%,3例内胚窦瘤患者随诊6～10年全部尤瘤存活.结论 原发性阴道恶性肿瘤的预后与分期、病理类型相关.阴道黑色素瘤患者以手术+化疗+免疫治疗取得了较好的效果,阴道内胚窦瘤患者以单纯化疗效果好.对于其他少见的病理类型,缺乏治疗经验,但基本上仍以手术+化疗为主.

Clinical analysis of 42 cases of primary malignant tumor in vagina

Objective To analyze the clinical characters,treatment and prognosis of primary malignant tumor in vagina.Methods A retrospective analysis of 42 patients diagnosed with primary malignant tumor in vagina in Peking Union Medical College Hospital(PUMCH)between Jan 1984 and Aug 2006 was performed.Results Primary malignant tumor accounted for 0.98%(42/4286)in the total gynecological malignant tumors during that period in PUMCH.According to the International Federation of Gynecology and Obstetrics(FIGO)staging system,19 cases were at stage Ⅰ,12 cases at stage Ⅱ,5 cases at stageⅢ,and 6 cases at stage Ⅵ.Thairteen cases were squamous carcinoma,13 cases were malignant melanoma,8 cases were adenocarcinoma.3 case8 were yolk sac tumor and 5 cases were other types.The majority of patients were treated with surgery combined with radiotherapy and chemotherapy.Up to August 2007,19 cases survived.18 cases were dead and 5 casefl were lost.The longest follow up was 10 years,with the median time of 2 years.The overall 2-year SUrvival rate was 60.6%.For stage Ⅰ,stage Ⅱ, and stage Ⅲ-Ⅵ,the 2-year survival rates were 71.3%.58.3%and 29.6%respectively.The 2-year survival rate of patients with squamous carcinoma Was 46.8%,malignant melanoma 72.9%,adenocarcinoma 20.0%and patients with yolk sac tumor were all alive tumor-free after 6-10 years'follow up.Conclusions The prognosis of primary malignant tumor in vagina is affected by clinical stage and histological type.A8 to malignant melanoma,radical surgery combined with chemotherapy and immunotherapy produce good effects.Patients with yolk sac tumor can be cured only with chemotherapy.As to other types,more treatment experiences are needed.