不同手术方法治疗原发性外阴癌51例及预后影响因素分析

The efficacy of different kind of operations for the treatment of primary vulvar cancer and the relative prognostic factors

目的:观察原发性外阴癌的手术治疗效果,并探讨影响其预后的相关因素。方法:51例经手术治疗的外阴癌患者行外阴广泛局部切除术7例,传统外阴广泛切除+腹股沟淋巴结切除28例,改良外阴广泛切除+腹股沟淋巴结切除16例。对不同的手术方式和有关预后因素进行比较。结果:根据2009年FIGO分期,手术患者中Ⅰ期31例,Ⅱ期5例,Ⅲ期12例,Ⅳ期3例;患者5年总体生存率为80.4%。行外阴广泛局部切除术的7例患者均达5年生存,行传统外阴广泛切除+腹股沟淋巴结切除的28例患者与改良外阴广泛切除+腹股沟淋巴结切除的16例患者5年生存率分别为78.6%和75.0%,差异无统计学意义(P>0.05)。腹股沟淋巴结阳性患者术后辅助放疗或放化疗的患者5年生存率差异无统计学意义(P>0.05)。结论:手术是外阴癌治疗的主要方法。早期发现、早期诊断和早期治疗是提高患者5年生存率的重要因素。外阴癌的治疗需要遵循个体化的综合性治疗原则。

Objective：To explore the efficacy of surgical therapy for primary vulvar cancer and the relative factors influencing the prognosis. Methods：Of the 51 patients having received operation for vulvar cancer, 7 accepted radical local excision,28 traditional radical vulvectomy plus inguinofemoral lymphadenetomy and 16 modified radical vulvectomy plus inguinofemoral lymphadenetomy. SPSS software was used to analyze the effects of different surgical procedures and the prognostic factors. Results： According to the International Federation of Gynecologyand Obstetrics 2009,31 patients were classified as stage I ,5 as stage ]1 , 12 as stage III and 3 as stage IV. The overall 5-year survival rate was 80.4%. All the 7 patients accepted radical local excision surgery survived more than 5 years ; the 5-year survival rates of the traditional radical vulvectomy group and the modified radical vulvectomy group were 78.6% and 75.0%, respectively. The difference was not significant （ P 〉 0.05 ）. The patients with positive inguinofemoral lymph nodes who had received chemoradiation therapy or radiation therapy demonstrated no great difference in 5-year survival rate（ P 〉 0.05）. Conclusions： Surgery is the most definite means for vulvar cancer. Early diagnosis and treatment are essential to improve the 5-yearival rate of the patients with vulvar cancer. Comprehensive and individualized therapy should he adopted for treatment of vulvar cancer.