CAJ | 학술논문

目的：对比外阴癌局部扩大切除＋个体化外阴缺损修复术与传统外阴广泛切除术的临床疗效，研究外阴癌外科治疗的优化方案。方法：自1997年6月至2012年6月共行外阴癌根治性手术35例，其中25例行标准外阴广泛切除术创面直接缝合（对照组），10例行外阴癌扩大局部切除＋个体化Ⅰ期修复（研究组）。观察对比两组切口愈合、术后外阴外形和功能状态及无复发生存率。结果：研究组皮瓣均完全存活。1例菱形皮瓣出现切口部分哆开，经保守治疗后20天愈合。对照组切口延迟愈合21例，占84%。研究组术后外阴形态和质地、排尿、性生活优于对照组。对照组和研究组的3年无复发生存率分别为66.6%和80.0%，无统计学差异，P=0.476。结论：相对于传统外阴广泛切除，外阴局部扩大切除＋个体化修复能降低术后切口延迟愈合率，改善外阴形态和功能，而不降低肿瘤控制率，是值得推荐的外阴癌治疗模式。
목적：대비외음암국부확대절제＋개체화외음결손수복술여전통외음엄범절제술적림상료효，연구외음암외과치료적우화방안。방법：자1997년6월지2012년6월공행외음암근치성수술35례，기중25례행표준외음엄범절제술창면직접봉합（대조조），10례행외음암확대국부절제＋개체화Ⅰ기수복（연구조）。관찰대비량조절구유합、술후외음외형화공능상태급무복발생존솔。결과：연구조피판균완전존활。1례릉형피판출현절구부분치개，경보수치료후20천유합。대조조절구연지유합21례，점84%。연구조술후외음형태화질지、배뇨、성생활우우대조조。대조조화연구조적3년무복발생존솔분별위66.6%화80.0%，무통계학차이，P=0.476。결론：상대우전통외음엄범절제，외음국부확대절제＋개체화수복능강저술후절구연지유합솔，개선외음형태화공능，이불강저종류공제솔，시치득추천적외음암치료모식。
Objective:To comPare the treatment outcome of vulvar carcinoma between conservative vulvectomy with individualized reconstruction and traditional radical vulvectomy,to exPlore an oPtimal surgical modality. Meth-ods:A total of 35 cases with vulvar carcinoma who underwent radical vulvectomies were divided into 2 grouPs:25 ca-ses who underwent standard radical vulvectomy with Primary closure of the wound were control grouP,the remaining 10 cases who underwent conservative vulvetomy with individualized reconstruction of the defects were included in thestudy grouP. Wound healing,PostoPerative vulvar shaPe and function,and recurrence free survival were observed and comPared between two grouPs. Results:All flaPs in the study grouP survived excePt 1 case that develoPed a dehis-cence and was cured after a 20 day with conservative care. Delayed wound healing develoPed in 21 cases(84%)in the control grouP. PostoPerative vulvar shaPe,texture,urinary,and sexual life were better in the study grouP than in the control grouP. 3-year recurrence free survival in the control grouP and study grouP were 66. 6% and 80. 0%,resPec-tively,P=0. 476. Conclusion:ComParing with traditional radical vulvectomy with Primary wound closure,conservative vulvectomy with individualized flaP reconstruction results in decreased delayed wound healing,better PostoPerative vulvar shaPe and function,without survival comPromise.