外阴和宫颈疣状癌７例临床分析

目的：探讨女性生殖系统疣状癌的临床、病理特点和影响预后的因素。方法：回顾性分析江西省妇幼保健医院收治的７例女性生殖系统疣状癌病例资料。结果：７例患者平均年龄为６２.２９岁，５例患者已绝经。发病部位以外阴居多（４例），宫颈３例。临床表现：病变累及外阴，以外阴赘生物伴瘙痒为主要症状；而病变在子宫颈者则表现为阴道不规则出血。有６例患者早期被误诊（８５.７２％）。４例外阴疣状癌按ＦＩＧＯ分期１例为Ⅰ期，３例为Ⅱ期。３例宫颈疣状癌按ＦＩＧＯ分期，Ⅰ期２例，占２８.５７％，Ⅱ期３例占４２.８６％，Ⅲ期２例占２８.５７％。５例患者行根治性手术治疗。１例宫颈癌ⅢＢ期患者行同步放化疗，另１例宫颈癌ⅢＢ期患者行单纯放疗。７例患者随访时间为１～９２个月，３例随访１～４９个月无异常发现，１例单纯手术的患者术后７２个月局部复发，１例行同步放化疗的患者１年后死亡，１例单纯手术的患者和１例行单纯放疗的患者失访。除１例出院后失访，６例患者１、３、５年的总生存率分别为８３.３３％（５／６）、５０.００％（３／６）和３３.３３％（２／６）。结论：生殖系统疣状癌是皮肤和黏膜鳞状细胞癌的一种亚型。发病年龄晚，以绝经后者多见。疣状癌缺乏特异性的临床表现，单发多见，少数伴发鳞状细胞癌。早期进行外科根治性治疗，并制定相关术后辅助治疗方案，才可能使患者有更大的获益。

Clinical analysis of seven cases of verrucous carcinoma in vulva and ervix

Objective：To describe and explore the clinical pathological features, treatment and prognosis of verrucous carcino- ma that is a rarely malignant tumor with poor diagnosis. Methods：Retrospective analysis was conducted on the clinical characteristics of seven women with verrucous carcinoma in female genital system at Jiangxi Maternal and Child Health Hospital from January 1989 to April 2008. Results ：The ages range from 34 to 78 years old and the average age was 62. 69 years. There are 5 menopausal patients. The tumor mainly involved vulva for 4 cases and cervix for 3 eases. The patients with vulva involvement usually presented neoplasm of vulva following with pruritus. The tumor originated in the cervix was found with presented abnormal vaginal bleeding. Seven patients （85.72%） were miscliagnosised in the early stage of the disease. One case about the vulva was in FIGO stage Ⅰ , 3 cases were in stage Ⅱ. According to FIGO staging about the cervix, 1 case was in the stage Ⅰ b2,2 cases were in the stage Ⅲ. Five patients underwent the radical surgery. The patient in stage Ⅲ received radiotherapy and anther one received synchronous radiotherapy and chemotherapy. The follow-up time was 1 to 92 months for 7 patients, 3 patients are doing well during the 1 to 49 months. Relapse in inguinal region was identified in one case within 72 months after operation. One patient died within 1 year after the synchronous therapy, 2 patients fail to be followed up included one patient who received the radiotherapy. Apart from 1 case failed to follow up after leaving hospital, the 1-, 3-, 5-year survival rates of six patients were respectively 83, 33% （5/6）, 50.00% （3/6）and 33.33% （2/6）. Conclusion ： Verrucous carcinoma in female genital system is the pathological subtype of squamous cell carcinoma of the skin and mucous membranes. Verrncous carcinoma is the rare disease in the clinical and it doesn＇t have the specific clinical manifestations, pathological examination is the only basis for its diagnosis. Radical surgery should be given earlier. Though there are too much cases with single verru- cons carcinoma, a few of the cases associated with squamous cell carcinoma can be found in fact. After the operative stage, we should make an adjuvant therapy in the terms of the pathology after the surgical operation, which will bring to the higher benefits of patients.