外阴癌39例手术治疗及预后分析

目的 总结我院治疗外阴癌的手术方式，分析与外阴癌预后有关的因素。方法 回顾性分析我院１９７９－１９９７年收治的３９例侵袭性外阴癌的临床资料。其中外阴病灶局部切除术５例、部分外阴根治术１３例及全外阴根治术２１例。应用ＳＰＳＳ地不同的手术方式秀关预后因素进行比较分析。结果 ３９例中鳞癌３３例，占８４．６％，其中高、中、低分化分别为２６、５、２例。临床分期为Ⅰ期７例（１７．９％）Ⅱ期１７例（４３．６％）

Surgical Treatment and Prognostic Analysis of 39 Cases Invasive Vulvar Cancer

OBJECTIVE: To summarize the procedure of operations and evaluate the prognostic factors in the invasive vulvar cancer. METHODS: Thirty nine cases with invasive vulvar cancer admitted in our hospital from 1979 to 1997 were retrospectively analyzed. Three kinds of operations were used: 5 by local excision, 13 by modified radical vulvectomy and 21 by radical vulvectomy. Statistical package for social sciences (SPSS) was used to compare the different strategy of operation and analyze the prognostic factors. RESULTS: Thirty three patients (84.6%) had squamous cell carcinoma and 26 of them (78.8%) were well differentiated and 2 poorly differentiated. Seven cases (17.9%) were in FIGO stage I; 17 (43.6%) in stage II; 13 (33.3%) in stage III, and 2(5.1%) in stage IV, 58.3% of tumor in stage I and II were lateral while 73.3% of tumor in stage III and IV were median type. Hospitalization time for local excision, modified radical vulvectomy and radical vulvectomy (separated and en-bloc incision) were 9.1, 20.6, 41.2 and 62.2 days (P < 0.01) and the incision infection rate were 0%, 30.8%, 66.7% and 88.9% (P < 0.01) respectively. Median survival time for stage I, II, II and IV were 132.0, 121.5, 67.5 and 21.5 months (P = 0.01) and the 5-year survival rates of them were 85.7%, 70.6%, 46.2% and 0.0% (P < 0.05) respectively. Median survival time for patients with or without lymph nodes involvement were 66.0 and 121.5 months (P < 0.01) and the 5-year survival rates were 30.0% and 71.5% (P < 0.05) respectively. Median survival time for well or poor differentiation were 97.0 and 64.0 months (P > 0.05) and the 5-year survival rates were 62.0% and 43.0% (P > 0.05) respectively. CONCLUSIONS: The important prognostic factors for invasive vulvar cancer were sites(lateral/median), stage, differentiation and lymph nodes involvement. Individualized treatment should be considered.