外阴鳞癌复发18例临床分析

Clinical features of recurrence of vulvar squamous cell carcinoma： analysis of 18 cases

目的分析外阴鳞癌复发的临床特点、治疗方法及影响预后的因素。方法回顾性分析18例外阴鳞癌复发患者的临床特点和治疗方法。18例患者年龄28-76岁，其中Ⅰ期3例，Ⅱ期8例，Ⅲ期6例，Ⅳ期1例。结果18例患者的复发率为21．3％（13／61）。初次复发部位以外阴局部复发为主，占61．1％（11／18），单纯腹股沟淋巴结复发占22．2％（4／18），腹股沟合并外阴复发者占16.7％（3／18）。单纯外阴局部复发多在1年以后出现，腹股沟淋巴结复发（包括合并外阴复发者）出现时间多在1年半以内，两者差异有统计学意义（P〈0．05）。复发后患者的治疗以手术为主，术前或术后可辅以放疗和化疗。单纯外阴局部复发者预后好，复发后患者的平均生存期为（63、2±8、1）个月，而有腹股沟淋巴结转移者预后差，死亡率高，复发后的平均生存期为（10．7±1.6）个月。两组间生存率差异有统计学意义（P〈0．01）。结论外阴癌复发后的临床特点和预后主要取决于复发的部位，治疗则以争取手术切除复发灶为主。

Objective To analyze the clinical characteristics of recurrence of vulvar squamous cell cancer and to explore the treatment thereof. Methods The clinical data of 18 patients vulvar squamous cell cancer, confirmed at the age 28 - 76, who developed recurrence were retrospectively analyzed. Results The overall recurrence rate was 21.3%. The time range between the primary operation and the discovery of primary recurrence was 2 months - 16 years. Local recurrence occurred in 11 of the 18 patients （61.1%）. Recurrence in groin alone occurred in 4 of the 10 patients （22. 2% ） and recurrence in both the vulva and groin occurred in 3 of the 18 patients （ 16.7% ）. Local recurrence occurred more than 1 year after the primary treatment and inguinal recurrence occurred mostly within 1 year after the primary treatment. The survival time of the patients with vulvar recurrence was （63. 2 ± 8.1 ） months, significantly longer than that of the patients with groin recurrence [ （ 10. 7 ± 1.6 ） months, P 〈 0. 01 ] . Conclusion The clinical characteristics and the prognosis of recurrent vulvar squamous cell cancer depend on the site of recurrence. Tha h^gt trt^tmt^nt antlnn for rPcnrrt^nt.t~ ig ~llr^Prxr