外阴癌手术方式与其预后的相关因素分析

Analysis of Different Surgeries in Vulva Cancer and Relative Prognostic Factors

目的:探讨手术方式对外阴癌预后的影响,并分析与外阴癌预后有关的因素。方法:回顾性分析广西医科大学附属肿瘤医院1985～2007年收治的54例经手术治疗的外阴癌患者临床资料,其中传统外阴广泛切除17例,传统外阴广泛切除+腹股沟淋巴结切除13例;改良外阴广泛切除9例,改良外阴广泛切除+腹股沟淋巴结切除15例。应用SPSS软件对不同的手术方式和有关预后因素进行比较分析。结果:①传统术式与改良术式患者的临床病理特征比较差异无统计学意义(P>0.05)。②改良外阴广泛切除的手术时间、术中出血量与传统术式比较差异无统计学意义(P>0.05),但术后外阴切口愈合时间明显缩短(P<0.05)。改良外阴广泛切除+腹股沟淋巴结切除的手术时间及术后外阴切口愈合时间较传统术式明显缩短(P<0.01;P<0.05),下肢水肿和麻痛的发生率显著下降(P<0.05),但术中出血量及术后腹股沟切口愈合时间的缩短,差异无统计学意义(P>0.05)。③生存分析显示改良术式的5年存活率较传统术式并无明显提高,复发率亦未明显下降(P>0.05)。COX模型多因素分析显示手术方式并非影响外阴癌患者预后的因素。结论:改良手术方式可改善外阴癌患者术中、术后情况,但并不影响预后。

Objective：The effects of different surgeries in vulva cancer and the relative prognostic factors were investigated.Methods：Fifty-four patients who had surgical treatment for vulva cancer were retrospectively reviewed from 1985 to 2007 in Guangxi Medical University Cancer Hospital.Of the 54 patients,17 had traditional radical vulvectomy,13 had additional inguinofemoral lymphadenectomy.9 patients had modified radical vulvectomy,15 had additional inguinofemoral lymphadenectomy.SPSS software was used to analyze the effects of surgery manners and prognostic factors.Results：① There were no significant differences in clinical and pathologic features between the traditional and the modified radical vulvectomy（P〉0.05）.② There were no significant differences in surgical time and blood loss between traditional and modified vulvectomy（P〉0.05）,but the recovery time of vulvar wounds in modified operation was shorter than that in traditional operation（P〈0.05）.The surgical time and recovery time of vulvar wounds in modified vulvectomy and groin nodes dissection were statistically shorter than those of traditional operation（P〈0.01;P〈0.05）,the occurrence of edema on lower limbs and numbness feeling were reduces markedly（P〈0.05）.However,there were no statistical differences in blood loss and recovery time of groin wounds（P〉0.05）.③In survival analysis,5-year survival time and relapse rates of modified operation were similar to traditional operation（P〉0.05）,furthermore,the recurrence rates did not significantly increase（P〉0.05）.Conclusions：The modified radical vulvectomy and inguinofemoral lymphadenectomy could reduce surgical and postoperative complications without compromising 5-year survival and increasing recurrence.