外阴癌复发(附55例临床分析)

Recurrent Squamous Cell Carcinoma of the Vulva Clinical Analysis of 55 Cases

目的:分析外阴癌外阴局部复发和区域淋巴结转移复发的临床特点及其预后,并探讨外阴癌的治疗。方法:回顾性分析我院1958～2000年收治的435例外阴原发性鳞癌中55例复发患者的临床特点和治疗。结果:复发率为12.6%(55/435)。55例复发患者中,32例单纯外阴局部复发,12例单纯腹股沟淋巴结转移,11例外阴局部复发合并腹股沟淋巴结转移。2年内复发、5年以上至10年内、10年以上复发分别占复发者的49.1%、25.5%、3.6%。外阴单纯复发和腹股沟淋巴结转移复发患者再次治疗后5年生存率分别为49.2%和6.4%,两者差异显著(P<0.01)。结论:单纯外阴复发预后较好,腹股沟淋巴结转移复发预后差。原发外阴癌患者腹股沟淋巴结的处理,仍应以手术治疗为主。为预防外阴局部复发,外阴白斑及其周围皮肤应一并切除,切缘离肿瘤尽可能大于2cm。如果肿瘤接近或侵犯尿道口、肛门而行保留尿道或保肛手术均应于术前或术后辅以放射治疗。

Objective:To analyze the Clinical characters and the prognosis of recurrent vulvar cancer,and explore the treatment of vulvar cancer.Methods:From1958-2000,there were435patients with vulvar squamous cell carcinoma treated at Cancer Hospital,Chinese Academy of Medical Science,55patients who developed recurrence of disease were retrospectively analyzed.Results:The overall recurrent rate was12.6%(55/435).Vulvar recurrences was observed in32patients,11patients with groin recurrences,12patients with recurrence of vulva and groin.27patients(49.09%)developed recurrence of disease from3～24months following primary therapy,14patients(25.45%)from5～10years,2patients(3.6%)after more than10years.The5year sur-vival rate after retreatment was49.2%for vulvar recurrences,6.4%for groin recurrence(P<0.01)Conclusion:The vulvar carcinoma has better prognosis compared with groin recurrences,the groin recurrences had a poor prognosis.Surgery is still to be considered the cornerstone of primary therapy for the groin nodes in patients with vulvar cancer.In order to reduce vulvar recurrence,the leukoplakia vulvae and adjacent normal skin should be removed,it is adequate to include more than2-centimeter skin margin.If urethral orifice or anus is involved or near to lesion and conservative surgery should be performed with pro-or postoperative adjuvant radiation.