【作者】 邹华；

【导师】 彭芝兰；

【作者基本信息】 四川大学 ， 妇产科学， 2007， 硕士

【摘要】 目的及背景：原发性外阴和阴道恶性肿瘤是女性生殖系统中少见的恶性肿瘤，主要发生于绝经后的妇女。近20年来外阴恶性肿瘤的治疗从单一术式到最大程度个体化、保守化，极大地改善了患者的生存质量。但阴道恶性肿瘤目前尚无统一的治疗模式。本文总结分析我院近6年收治的原发性外阴、阴道恶性肿瘤患者的临床特征和随访资料，研究影响原发性外阴癌和阴道癌复发、转移等的相关危险因素，以期提高治疗水平。方法：回顾性分析我院2001年1月-2006年12月间收治的102例原发性外阴癌，25例阴道癌患者的临床及随访资料。使用SPSS12.0统计软件包对不同期别，不同手术方式及其他有关预后因素进行分析。结果：(1)临床资料：①102例外阴恶性肿瘤患者的平均发病年龄49.7岁；阴道恶性肿瘤患者的平均年龄为49.04岁。②外阴恶性肿瘤患者中己绝经者57例(55.9%)；阴道恶性肿瘤患者中已绝经者14例(56.0%)。(2)统计分析：①手术-病理分期：Ⅰ/Ⅱ期，Ⅲ/Ⅳ期外阴及阴道恶性肿瘤患者生存率相比较均有统计学差异(P<0.05)。②肿瘤大小：外阴及阴道恶性肿瘤患者中，肿瘤最大直径大于等于4cm者与小于4cm者相比较，两组差异均有统计学意义(P<0.05)。③脉管浸润：外阴及阴道恶性肿瘤患者中，有脉管浸润者与无脉管浸润者相比，前者的生存率显著低于后者(P<0.05)。④淋巴结受累：外阴及阴道恶性肿瘤患者按受累淋巴结数目分组，超过2个淋巴结阳性组生存率明显较低，差异有统计学意义(P<0.05)。⑤病理类型：外阴鳞癌患者的生存率高于非鳞癌组(P<0.05)。⑥阴道受侵长度：阴道恶性肿瘤患者的阴道受侵长度与预后有相关性，三组间差异有统计学意义(P<0.05)。结论：(1)原发性外阴癌及阴道癌的病理类型仍以鳞癌居多，其他病理类型的发病比例也无明显变化；(2)经单因素分析，外阴恶性肿瘤患者的独立预后因素有病理学分期、病理类型、肿瘤大小、淋巴结受累及脉管浸润；病理分期、肿瘤大小、淋巴结受累、受侵长度及脉管浸润是阴道恶性肿瘤的主要独立预后因素。(3)上述单因素分析结果有意义的预后因素经多因素分析显示病理学分期、病理类型、淋巴结受累和脉管浸润是VC最主要的独立预后因素；其他因素无显著独立预后意义。更多还原

【Abstract】 Objective: To summarize clinicopathologic features, surgery and follow-up information of patients with vulvar carcinoma (VC) and vaginal carcinoma (VaC) of our hospital in recent 6 years; to investigate characteristics of recurrence and metastasis of vulvar carcinoma and vaginal carcinoma. Methods: A retrospective analysis of 127 patients with primary invasive vulvar carcinoma or vaginal carcinoma treated at our hospital between 2001 and 2006 was conducted. The Cox proportional hazards model and Chi-Square test were used to assess independent variables as prognostic factors for treatment failure. Result: (1)clmical data:①The mean age of the 102 VC patients was 49.7 years old, while the mean age of the 25 VaC patients was 49.04 years old.②The number of VC patients with menopause was 57, while the number of VaC was 14.(2)Results of statistic analysis:①Pathological stage: Prognosis was much poorer in advanced stage for both of the VC and VaC patients (P<0.05 ) .②Tumor size: VC and VaC patients with tumors larger than 4cm in diameter had poorer prognosis (P<0.05) .③Vascular invasion: Prognosis was much poorer for patients with vascular invasion (P<0.05).④lymph node involvement: In all the 102 VC patients, 2 or more lymph node metastasis occurred in 23, and these patients had a significantly lower survival rate compared with those who did not occur or had only one lymph node involved(P<0.05).And so were the VaC patients.⑤Pathological type: VC patients with squamous-cell type hade better prognosis than those with non-squamous-cell type(P<0.05).⑥Length of the vagina involved: VaC patients with longer vagina involved had poorer progno-sis, which had statistic significance (P<0.05) .Conclusions: (1)Squamous-Cell type still accounts for significantly larger proportions in VC and VaC, while the proportions of other histological types remain the same. (2) Single-factor analysis indicated that FIGO stage, pathological type, tumor size, lymph node involvement and vascular invasion had independent prognostic significance in VC. And the FIGO stage, tumor size, lymph node involvement, length of the vagina involved and vascular invasion had independent prognostic significance in VaC. (3) Multiple-factor analysis indicated that FIGO stage, pathological type, lymph node involve-ment and vascular invasion had independent prognostic significance in VC.更多还原