| Background:Vulvar carcinoma is a rare malignant tumor of the female genital tract,accounting for about 4-5%in the female reproductive system malignant tumor,with the age increased its rate of rise,and is especially prevalent in postmenopausal women,although vulvar tumors located in the superficial,the theory should be easy to find and early diagnosis,but in fact,most of the patients are diagnosed in advanced stage,and threatens the life and health of women.In recent years,although with the improvement of technology of radiotherapy and chemotherapy,chemotherapy and radiotherapy have been slowly and into a subtle change in the treatment of vulvar cancer,but because the tumor incidence rate is low,with wide distribution,dispersion,accumulation of a large case control study is difficult,there were insufficient and treatment methods are not unified the problem,so there are many disputes in the treatment process,it is difficult to form a consensus,but in the course of treatment of vulvar cancer,surgery can be achieved if primary tumor resection margins were negative,and not because of injury caused by sphincter premise incontinence,surgical resection of vulva cancer treatment is still the best choice,it is the consensus of vast majority of gynecological oncologist.The treatment of previously involved in female genital tumors to achieve local disease control and complete resection of the lesion,rather than restore their morphology and function,surgical resection due to a large range,and normal body image change resulting in serious sexual dysfunction and defecation patterns,and quality of life after surgery fall is very common.In recent years,vulva cancer postoperative vulva appearance,adjacent organ function preserving and improving the quality of life and reduce the postoperative effect on sexual function,cause gynecological oncologist more and more attention to the overall trend of surgical treatment of vulvar cancer is on the premise of assurance of treatment,as far as possible to narrow the scope of operation and improve the postoperative quality of life.According to the size,location,depth of invasion and adjacent organs of the patient’s tumor,the individualized surgical excision range and comprehensive treatment plan should be emphasized.In addition,we think,the appropriate vulvae reconstruction treatment can not take by some standardized program;instead,it needs to be the experts who are familiar with general principles of gynecological tumor surgery and plastic surgery,knew a lot of new technology and the best method can selectively performed on different patients.Therefore,through the discussion of the surgical treatment of vulvar cancer application in vulvar reconstruction in innovation and individualized surgical treatment and retrospective follow-up analysis,preoperative and postoperative multi contrast evaluation,application summary of these surgical methods in vulvar cancer surgery,to surgical treatment looking for a more appropriate and individualized;provide alternative treatment of new research by the violation of this special type of perineal skin defect and vulvar cancer patients for surgical treatment of urethral carcinoma of vulva in lower section,provides new ideas for improving the quality of life of patients with vulvar cancer.Chapter1 A new method of urethral reconstruction in the operation of early-stage vulvar carcinoma that invasion the lower urethra segmentObjective:To evaluate the surgery feasibility and its curative effect of Transposition of urethroplasty after partial urethrectomy in the treatment of patients with early-stage vulvar cancer.After the operation,two aspects of urination and urinary bladder residual urine were evaluated,and the effectiveness of the operation was evaluated,and it was expected to be applied in clinical practice.Methods:Form Decenber,2006 to Decenber,2016,26 women diagnosed with stage-Ⅱor Ⅲ vular cancer were selected for the Transposition of urethroplasty after partial urethrectomy + video endoscopic inguinal lymphadenectomy + radical vulvectomy.Preoperative data,surgical technique and the follow up outcomes were analyzed.The measurement of urinary flow rate(including excretion of urine,maximum urinary flow rate Qmax,urination time)and ultrasonic measurement of urinary bladder residual urine were used to evaluate the feasibility of the operation.1.Determination of urinary flow rate:in 3 days after catheter removal in our hospital department of Urology do urodynamic examination,the use of Medtronic made in Denmark urodynamic analyzer,the three parameter factors check the cost,we use only the urine flow rate determination evaluation comparison before and after surgery.The quantity of urine is more than 150ml for the effective value,maximum urine flow rate Qmax>20ml/s as normal,urination time less than 30 seconds is normal.2.Bladder residual urine measurement:all patients in the day after catheter removal by ultrasonic residual urine volume detection,using GE(GM)voluson 730 Pro ultrasonic detection system,we take the bladder residual urine volume 50ml as the standard>50ml for suspected urinary retention and timely inserting catheter,<50ml is normal.Results:1.Evaluation of TUPU effectiveness.The novel TUPU was successfully done in 26 patients,Mean operative time was 26.1±3.2mins(20-33mins).Average blood loss was 10.3±2.5ml(8-20ml).Mean indwelling catheters time was 11.8±2.3day(10-21day).Mean follow-up time was 3 years and 4 months.No major intraoperative complication was found.Regarding to the postoperative complication,one patient suffered the urinary tract infection who was cured after anti-infection,monitor blood glucose;one patient suffered urine retention after remove catheter who was cured after continue indwelling catheter and acupuncture treatment;and one experienced odynuria was cured after anti-infection,alkalized urine and use of pain-killer tablet.With the follow up there was one patient whose tumor recrudesce was found around urethra and other one patients’tumor recrudesce was found in the vulva cuts,We performed local radiotherapy on them,and rest of the patients(92.3%)with no disease recurrence at the time of writing this report.2.The urine flow rate was evaluated by three parameters of urine flow rate and the evaluation criteria of ultrasonic detection of urinary bladder residual urine.All patients had no urinary incontinence or urinary system diseases,urinary flow rate for preoperative examination before surgery done within 1 weeks,26 patients underwent preoperative uroflowmetry,evaluated according to three parameters of urine flow rate,urine volume between 190-280ml,with an efficiency of 100%,maximum urine flow rate Qmax in 18.4-25.6ml/s,the normal rate of 94.1%,voiding time in 26-39 seconds between the normal rate was 94.3%,postoperative urodynamic examination in 3 days after catheter removal,according to the three parameters of urine flow rate assessment,26 patients after catheter removal after the urine flow rate examination,urine volume between 175-300ml the efficiency is 100%,the maximum urinary flow rate in Qmax between 17.2-22.8ml/s,the normal rate of 92.3%,voiding time in 25-43 seconds between the normal rate was 93.4%,the difference was not significant,no statistical significance(P>0.05);the removal of catheter after operation The ultrasonic residual urine volume detection,25 cases of patients with bladder residual urine volume<50ml,only 1 cases of urinary retention,residual urine 200ml,normal rate was 96.1%,the symptoms of urinary retention disappeared after surgery and inserted into the catheter combined with acupuncture therapy prolonged one week after removal of the catheter,bladder residual urine volume is only 1Oml.Conclusion:The treatment Of patients with stage-II vular cancer by using TUPU surgery is feasible and safe,the patient can normal urinate by her own,and it’s a effective way of treatment with special types of vulvar cancer.there was no obvious change in urine flow rate after operation.Chapter 2 The Application of local flap in the repair of middle and small size of skin defects after vulvar cancer operation and its influence on sexual lifeObjective:The aim of this study is to discuss in vulvar carcinoma after radical vulvectomy,using the method of partial double kite flap and "V-Y" or "Z" flap plasty of vulvar cancer after surgery in the small vulva skin defect was repaired,preliminary discussion on practical application of the vulva in vulvar cancer surgery after resection of small skin defect in clinical application,to provide a clinical basis for surgical treatment of such patients,and according to the female sexual function index scale(FSFI)assessment of quality of life in patients compared with the preoperative after operation.Methods:From May 2013 to August 2016 in Zhujiang Hospital,Southern Medical University,11 cases of young and still have sexual needs were selected as a group,the vulvar cancer patients underwent local resection of vulva or modified radical vulvectomy skin after the defects,using "V-Y" and"Double kite"flap,"Z" type of flap to repair the skin defect of vulva the repair and reconstruction of vulva contour,pathology and clinical follow-up data of all cases were complete.The general and clinical data of patients include name,age,pathology,histological type,differentiation,clinical stage,lymph node metastasis,tumor size and so on.The patients ranged in age from 40-46 years old,the average age(43±2.35)years old,since the first patients in the study the longest follow-up is 2 years,mean follow-up is 1 years and 2 months,according to the International Federation of gynecology and Obstetrics(FIGO)clinical staging standard of vulvar cancer staging,11 cases 6 patients with stage IA,4 cases of IB patients,1 cases of stage II patients,all diagnosed histologically.Histological type,11 cases were squamous cell carcinoma,preoperative pelvic MRI examination to check the pelvic lesions invasion and pelvic lymph node enlargement preoperative suspicious,are fully informed and consent,using the female sexual function index scale(FSFI)questionnaire of 19 questions in the a preliminary assessment of the quality of life of patients with preoperative and postoperative alignment,and to evaluate the quality of life.After excision of the vulvar tumor,the area of the skin defect was minimum 2.9cm x2.4m,the maximum 5cm×4.4cm,and the mean area of the defect was 3.4cm×3.2cm.Results:1.In all 11 patients,10 cases of postoperative flap incision were healed,1 case of "Z"flap plasty in patients with partial dehiscence with incision infection,2 weeks later with dressing the wound was heal;healed patients were discharged,we communicate with the patients and confirm again with the operation area,whether there is sensory disturbances,such as numbness,paralysis,pain and lack of feeling abnormal,no patients reflect the operation skin paresthesia.After 6 months of follow-up period,obvious scar flap healing was found in all cases,the vulva forms a good skin elasticity of the vulva skin flap was good,only 1 case with age of 46,patient of postoperative ostium vaginae scar contracture and stenosis,the remaining patients can hold 2 fingers in vagina,there was no obvious the vagina scar or stenosis;1 case of underwent double kite flap with skin,the flap edge pigmentation,no significant difference in the rest of the patients,postoperative flap and surrounding vulva skin color;smooth urination,no patient have been found in cases of vulvar cancer recurrence.2.11 cases of patients underwent preoperative quality of life of women score(FSFI),there were 9 patients in the postoperative 6 months after having sex,but only 7 of the patients in the follow-up process is willing to accept the investigation of the quality of life of women FSFI score again,we did the 7 patients the postoperative FSFI score comparison showed that preoperative 7 patients quality of life has already declined.Conclusion:1.All the patients were discharged successfully.During the follow-up period,there was no sensory dysfunction,numbness,paralysis or pain sensation in the operative area.No patient showed abnormal skin sensation,good appearance and integrity in the operative area.In particular,sexual arousal and vaginal lubrication were significantly reduced.2.In patients with vulvar cancer by "Z","V-Y" type forming flap and"double kite"flap of the three local skin flap to repair skin defect of vulva in small groups in sexual arousal and vaginal lubrication degree,compared with the preoperative and postoperative dimensions,the quality of sexual life decreased significantly compared with that before operation,especially in two aspects,including sexual arousal and vaginal lubrication.But there was no significant change in the three aspects of orgasm,satisfaction and pain.However,there was no significant change in orgasm,satisfaction and pain. |
PDF Full Text Request