CAJ | 학술논문

目的：分析外阴鳞癌的临床表现,总结治疗方法,评价手术和放化疗的疗效及愈后。方法对诊治的83例随访满1年的外阴鳞癌进行回顾性分析。结果83例外阴鳞癌患者中,95.2%有前驱疾患；I期和II期患者60例(72.3%),Ⅲ期和Ⅳ期患者23例(27.7%),平均发病年龄为56.2岁,其中55例患者绝经(66.3%)。手术78例,单纯放化疗5例。手术方式包括：外阴局部切除10例(12.8%),单纯外阴切除4例(5.1%),外阴局部根治37例(47.5%),根治性外阴切除27例(34.6%)。51例(65.4%)合并单侧或双侧腹股沟股浅或深淋巴结的切除,术后辅以放化疗的有34例,其中1例术前行放化疗。完全缓解65例(78.3%),未治愈并逐渐进展18例(21.7%)。复发11例(16.9%)。总体5年的缓解率为68.7%(57/83)。切缘或紧邻切缘阳性者即使术后辅予放射治疗,其复发率仍较高,为27.8%。肿瘤浸润超过5mm或累及真皮以下的患者,复发率高达34.6%。11例复发患者,1例手术,1例放疗,余9例均进行了手术联合放疗以及化疗的联合治疗,4例进展,7例缓解,但其中4例在5年内反复复发。结论外阴鳞癌早期病例占多数；主要治疗手段为手术治疗,术后放疗的意义待进一步观察；疾病分期与疗效相关；手术切缘不净和浸润较深的患者复发率高,复发病例总体疗效不佳。
목적：분석외음린암적림상표현,총결치료방법,평개수술화방화료적료효급유후。방법대진치적83례수방만1년적외음린암진행회고성분석。결과83예외음린암환자중,95.2%유전구질환；I기화II기환자60례(72.3%),Ⅲ기화Ⅳ기환자23례(27.7%),평균발병년령위56.2세,기중55례환자절경(66.3%)。수술78례,단순방화료5례。수술방식포괄：외음국부절제10례(12.8%),단순외음절제4례(5.1%),외음국부근치37례(47.5%),근치성외음절제27례(34.6%)。51례(65.4%)합병단측혹쌍측복고구고천혹심림파결적절제,술후보이방화료적유34례,기중1례술전행방화료。완전완해65례(78.3%),미치유병축점진전18례(21.7%)。복발11례(16.9%)。총체5년적완해솔위68.7%(57/83)。절연혹긴린절연양성자즉사술후보여방사치료,기복발솔잉교고,위27.8%。종류침윤초과5mm혹루급진피이하적환자,복발솔고체34.6%。11례복발환자,1례수술,1례방료,여9례균진행료수술연합방료이급화료적연합치료,4례진전,7례완해,단기중4례재5년내반복복발。결론외음린암조기병례점다수；주요치료수단위수술치료,술후방료적의의대진일보관찰；질병분기여료효상관；수술절연불정화침윤교심적환자복발솔고,복발병례총체료효불가。
Objective To analyze the clinical manifestations of squamous cell carcinoma of the vulva, and summarize treatment methods to evaluate the efficacy and prognosis. Method 83 cases of vulvar squamous cell carcinoma were followed up at least 1 year were analyzed retrospectively. Result In the 83 cases, patients with preexisting dermato-ses accounted for 95.2%;60 cases ( 72.3%) were in stageIandII, and 23 cases ( 27.7%) were in stageⅢandⅣ;The average age of onset was 56.2 years, and there were 55 post-menopausal cases ( 66.3%); 78 cases had surgery, 5 cases received simple radiochemotherapy, and surgery type included: local excision ( 10/78, 12.8%) , simple vulvectomy ( 4/78, 5.1%) , radical local excision ( 37/78, 47.5%) , and radical vulvectomy ( 27/78, 34.6%);There were 51 cases ( 65.4%) with unilateral or bilateral superficial or deep inguinal-femoral lymphadenectomy, and 34 cases with adjuvant radiochemotherapy, including 1 case that had preoperative radiotherapy. 65 cases ( 78.3%) were in complete remission, and 18 cases ( 21.7%) developed progression, while 11 patients ( 16.9%) relapsed. Overall 5-year response rate was 68.7% (57/83). Patients with positive margin or positive close margin received postoperative adjuvant radiotherapy still had relatively high recurrence ( 27.8%) . And patients with tumor invasion over 5 mm or over-dermis in-volvement had high recurrence of 34.6%. Of the 11 cases of relapsed patients, 1 had surgery, 1 received radiotherapy, and other 9 cases were treated with surgery + radiotherapy or chemotherapy, while 4 cases progressed, 7 cases in remis-sion, but in which 4 cases experienced repeated recurrence within 5 years. Conclusion Early stage of squamous cell car-cinoma of the vulva is in the majority, and the primary procedure is surgery, as the efficacy of postoperative radiotherapy is to be determined. The stage of the disease is correlated with efficacy, the patients with positive surgical margin or deep invasion had a higher recurrence rate, and overall efficacy in relapsed cases is poor.