原发性阴道腺癌24例临床分析

Primary Adenocarcinoma of Vagina——Attaching 24 Cases Clinical Analysis

背景与目的:原发性阴道腺癌的发病率低,治疗困难,预后差。本文将对其临床特点、治疗和预后进行探讨。方法:对1964-1999年我院收治的24例原发性阴道腺癌进行回顾性分析。结果:24例原发性阴道腺癌患者的临床分期为:Ⅰ期5例,Ⅱ期10例,Ⅲ期5例,Ⅳ期4例;主要临床症状为阴道流血和流水。病变位于阴道前壁8例(33.3%),后壁5例(20.8%),左侧壁1例(4.2%),多壁10例(41.7%)。24例患者均行放射治疗(体外和腔内放疗);2例同时行化疗,8例因放疗后肿瘤未控、复发或转移而行化疗。病人的3年生存率为47.3%,5年生存率为34.2%;Ⅰ+Ⅱ期病人的平均生存时间60.3个月,明显长于Ⅲ+Ⅳ期病人的平均生存时间14.8个月(P<0.01);年龄>40岁与≤40岁病人的平均生存时间无显著性差异(P>0.05)。局部复发8例,占57.8%;肿瘤局部复发是治疗失败的主要原因。结论:原发性阴道腺癌采用放疗为主的综合治疗,但预后较差,分期是影响预后的重要因素。

Background & Objectives: The incidence of primary vaginal adenocarcinoma was lower and its treatment was difficult and its prognosis was worse. This study was designed to explore the clinical characters, treatment, prognosis of primary vaginal adenocarcinoma in this paper as the incidence of primary vaginal adenocarcinoma was lower, its treatment was difficult and its prognosis was worse. Methods: From 1964 to 1999, twenty four patients were reviewed retrospectively in our hospital. Results: The main clinical symptoms were vaginal bleeding and discharge. The median age was 49 years old. Five patients were classified as stage Ⅰ, 10 patients were stage Ⅱ, 5 patients were stage Ⅲ, and 4 patients were stage Ⅳ. The lesion was located in the anterior wall in 8(33.3%) patients, the posterior wall in 5(20.8%) patients, the left wall in 1 patient and the multiple walls in 10(41.7%) patients.Twenty four patients were generally received radiotherapy, including external beam and intracavitary irradiation. Two patients were concurrently received chemotherapy and irradiation, Eight patients were received chemotherapy as the tumor was not control and recurrent or metastatic. The survival rate of 3 years was 47.3% and that of 5 years was 34.2%. The survival mean time of patients with stage Ⅰ and stage Ⅱ was 60.3 months obviously much longer than 14.8 months of patients with stage Ⅲ and stage Ⅳ, and they were significantly statistical difference (P< 0.01). But the survival mean time of patients more than 40 years and less than or equal to 40 years was not significantly statistical difference. Eight patients had local recurrence, which is the main reason of failure treatment. Conclusions: Primary vaginal adenocarcinomas should mainly be adopted combined treatment depending on radiotherapy, but the prognosis was worse, the stage was the important factors affecting on the prognosis.