原发性阴道癌的治疗方法探讨

Rational Treatment of Primary Carcinoma of Vagina

目的:探讨原发性阴道癌的治疗方法以及预后相关因素。方法:对1978年至1995年治疗的56例原发性阴道癌进行回顾性分析,其中单纯放射治疗25例,放射治疗加化疗20例,单纯手术4例,手术加化疗7例。结果:总5年存活率为62.5％。单纯放疗或放疗加化疗的5年存活率分别为52％和75％,差异显著(P<0.05);单纯手术或手术加化疗的5年存活率分别为50％和71.4％,差异显著(P<0.05)。临床早期、病变局限阴道1/3段、病理Ⅰ～Ⅱ级、手术或放疗加用化疗者预后好,手术组和放疗组预后差异无显著性。结论:原发性阴道癌治疗应个体化,采取彻底的手术治疗或合理的放射治疗均可取得较满意的疗效,但加用化疗特别是区域性动脉化疗其存活率可较大提高。

Objective: To explore the treatment and prognostic factors of primary carcinoma of the vagina. Methods: 56 cases of primary vaginal cancer were analyzed retrospectively. 25 were treated by radiotherapy alone; 20 by radiotherapy plus chemotherapy,4 by surgery alone and 7 by surgery plus chemotherapy. Results:The overall 5 - year survival rate was 62.5%. The survival rate in patients treated by radiotherapy alone was 52% ,and by radiotherapy plus chemotherapy was 75% . The difference was significant (P<0.05). The 5 -year survival rate in patients treated by surgery alone was 50 % , and by surgery plus radi otherapy was 71.4% ( P < 0. 01 ). When the carcinoma was in its early clinical stage, or limited to one - third of the vaginal canal, pathologically grade Ⅰ and Ⅱ , and treated by surgery plus chemotherapy or radiotherapy plus chemotherapy, the prognosis is usually favorable. There was no obvious difference between surgery group and rodiotherapy group. Conclusion: The treatment of primary carcinoma of the vagina should be individualized. The results were satisfactory when treated by radical operation or rational radiotherapy. The survival rate could be greatly increased by combining chemotherapy, especially hypogastric artery chemotherapy.