83 例外阴浸润性鳞癌的临床分析

目的分析外阴鳞癌的临床表现，总结治疗方法，评价手术和放化疗的疗效及愈后。方法对诊治的83例随访满1年的外阴鳞癌进行回顾性分析。结果83例外阴鳞癌患者中，95．2％有前驱疾患；Ⅰ期和Ⅱ期患者60例（72．3％），Ⅲ期和Ⅳ期患者23例（27．7％），平均发病年龄为56．2岁，其中55例患者绝经（66．3％）。手术78例，单纯放化疗5例。手术方式包括：外阴局部切除10例（12．8％），单纯外阴切除4例（5．1％），外阴局部根治37例（47．5％），根治性外阴切除27例（34．6％）。51例（65．4％）合并单侧或双侧腹股沟股浅或深淋巴结的切除，术后辅以放化疗的有34例，其中1例术前行放化疗。完全缓解65例（78．3％），未治愈并逐渐进展18例（21．7％）。复发11例（16．9％）。总体5年的缓解率为68．7％（57／83）。切缘或紧邻切缘阳性者即使术后辅予放射治疗，其复发率仍较高，为27．8％。肿瘤浸润超过5mm或累及真皮以下的患者，复发率高达34．6％。11例复发患者，1例手术，1例放疗，余9例均进行了手术联合放疗以及化疗的联合治疗，4例进展，7例缓解，但其中4例在5年内反复复发。结论外阴鳞癌早期病例占多数；主要治疗手段为手术治疗，术后放疗的意义待进一步观察；疾病分期与疗效相关；手术切缘不净和浸润较深的患者复发率高，复发病例总体疗效不佳。

Clinical analysis of 83 cases of invasive squamous cell carcinoma of the vulva

Objective To analyze the clinical manifestations of squamous cell carcinoma of the vulva, and summarize treatment methods to evaluate the efficacy and prognosis. Method 83 cases of vulvar squamous cell carcinoma were followed up at least 1 year were analyzed retrospectively. Result In the 83 cases, patients with preexisting dermatoses accounted for 95.2% ; 60 cases （72. 3%） were in stage I and II , and 23 cases （27. 7% ） were in stage III and IV ; The average age of onset was 56. 2 years, and there were 55 post-menopausal cases （66. 3%） ; 78 cases had surgery, 5 cases received simple radiochemotherapy, and surgery type included： local excision （10/78, 12.8%）, simple vulvectomy （4/78, 5. 1%）, radical local excision （37/78, 47.5%）, and radical vulvectomy （27/78, 34. 6%） ; There were 51 cases （65.4%） with unilateral or bilateral superficial or deep inguinal-femoral lymphadenectomy, and 34 cases with adjuvant radiochemotherapy, including 1 case that had preoperative radiotherapy. 65 cases （78. 3%） were in complete remission, and 18 cases （21.7%） developed progression, while 11 patients （16. 9%） relapsed. Overall 5-year response rate was 68.7% （57/83）. Patients with positive margin or positive close margin received postoperative adjuvant radiotherapy still had relatively high recurrence （27.8%）. And patients with tumor invasion over 5 mm or over-dermis involvement had high recurrence of 34. 6%. Of the 11 cases of relapsed patients, 1 had surgery, 1 received radiotherapy, and other 9 cases were treated with surgery ＋ radiotherapy or chemotherapy, while 4 cases progressed, 7 cases in remission, but in which 4 cases experienced repeated recurrence within 5 years. Conclusion Early stage of squamous cell carcinoma of the vulva is in the majority, and the primary procedure is surgery, as the efficacy of postoperative radiotherapy is to be determined. The stage of the disease is correlated with efficacy, the patients with positive surgical margin or deep invasion had a higher recurrence rate, and overall efficacy in relapsed cases is poor.