外阴癌临床治疗309例报告

目的　分析外阴癌不同治疗方法的结果 ,并探讨其复发转移的特征。方法　采用回顾性研究的方法 ,对 30 9例外阴癌的临床治疗结果进行分析。结果　 30 9例患者总的 5年生存率为6 7.9% ,Ⅰ、Ⅱ、Ⅲ及Ⅳ期的 5年生存率分别为 86 .9%、82 .5 %、5 9.2 %和 43.6 %。总的治疗失败率为49 .8% (其中 2年内失败者占 6 9.5 % ) ;复发部位依复发时间不同而异 ,83.6 %的腹股沟、盆腔及远处转移发生在治疗后 2年内 ,外阴局部复发占 2年后治疗失败的 81.1%。外阴癌复发转移与年龄无关。Ⅰ期癌各种治疗方法的生存率及治疗失败率差异无显著性。Ⅱ期癌外阴根治性切除 腹股沟清扫术生存率较高 (P <0 .0 5 ) ;腹股沟淋巴结阳性者 ,手术治疗的失败率显著低于放疗 (P <0 .0 5 ) ;腹股沟淋巴结阴性者 ,两种治疗方式差异无显著性 ;腹股沟预防照射剂量Dm达 6 0Gy者 ,失败率显著低于剂量Dm <6 0Gy者 (P <0 .0 5 )。结论　早期外阴癌应施行外阴根治性切除 ,加施预防性淋巴清扫或腹股沟足量放疗 ;对中晚期患者 ,争取切除原发灶及行腹股沟淋巴清扫 ,并辅以术前、术后放疗。

Carcinoma of the vulva: A report of treatment.

OBJECTIVE: To analyse the outcome of various treatments for vulvar cancer and to investigate the characteristics of the recurrence and metastasis. METHODS: A total of 309 patients with carcinoma of vulva were analyzed retrospectively. RESULTS: The overall 5-year survival rate was 67.9%. That for stage I, II, III and IV was 86.9%, 82.5%, 59.2% and 43.6%, respectively. Treatment failure was seen in 49.8% of the treated cases, and it occurred within 2 years after primary treatment in the majority of the cases. Inguinal and pelvic recurrences, and distant metastases occurred within 2 years, while local recurreuce mostly after 2 years. Recurrence rate was not related to age of the patients. For stage I cancer, there was no difference in the results of different methods of treatment, but for stage II cancer, wide local resection plus inguinal lymphadenectomy was a better choice. In patients with regional lymph node metastases treated by nodal resection, it was less likely to recur than did radiotherapy. If no nodal involvement, the outcome of the two types of treatment was not different. Higher dose of radiation (Dm > or = 60 Gy) was better than lower dose (40-50 Gy) for prevention of recurrence. CONCLUSION: For early stage vulvar cancer, in addition to radical resection of vulva, preventive dissection of inguinal lymph nodes, or full dose radiation of the inguinal region, leads to better therapeutic results. For advanced cases, radical resection of the primary tumor with pre- and post-operative radiation, and inguinal lymph nodal disection, whenever possible, should be performed.