Clinical Analysis Of85Cases Of Vulval Cancer

Objective: Vulvar cancers are rare disease with an incidence rate thatincreases with age. Due to a change in sexual behavior and an increased rate ofHPV infection among younger women,increased incidence of this disease hasto be expected. By the retrospective analysis the clinical data of the past10years Vulvar Cancer patients in our hospital.This study is to know theincidence trend,the risk factors, the change of diagnosis,treatment and theprognosis factors, in order to search the new method of diagnosis andtreatment. We can realize the gap of diagnosis and treatment at home andabroad, then improve the ability of diagnosis and treatment and reducecomplications.Methods: from2002-10to2012-09,85patients’s clinical data of Vulvarcancer who were treated in the second hospital of jilin university were collected and analyzed by retrospective comparative methods：（1）To analyze the incidence trend of Vulvar Cancer.（2）To analyze the invasion related factors of Vulvar Cancer.（3）To analyze the diagnostic methods and its reliability of VularCancer.（4）To analyze the effect of Peroperative Period recuperative of VulvarCancer patients by different methods of surgery.（5）To analyze the infiltration and metastasis of different type ofpathological tissue of differentiation.Use SPSS19.0application software for the statistics. Use chi-aquare and Ftest statistic methods to analyze the clinical data. Use P <0.05as the judgmentstandard.Results:1. We treated85VC cases during10years and3391cases of female reproductive system malignant tumors in the in our hospital, the percentage ofVC was2.89%(85/3391). The age of the VC patients was between24to88years old, the mean age was57.09±12.93years old. Compares the patient’s agedistribution in five periods, found that the trend of the age of VC had beenjuvenescence（F=6.013，P=0.016＜0.05）. The differences between the city andcountryside may have some influence to the onset of Vulvar Cancer.Countryside patients is more than city patients.The patients of distribution inthis two groups was remarkably different（F=4.16，P=0.045＜0.05）,but theproportion of urban patients in different years has no different（χ2=0.080，P=0.777）.2. Patients of vulvar cancer with menopause was58.82%(50/85),proportion of postmenopause had been dropped, from the first two years of87.5%(7/8) to the last two years of48.72%(19/39), however theno-menopause’s proportion had been rised, from12.5%(1/8) to51.28% (20/39). But this change has no significance different. Positive correlationMalignant tumor history and the history of genital surgery had some correlationwith the onset of Vulvar Cancer by statistical analysis（P＜0.05）.3.4cases of vulvar cancer patients is misdiagnoze, accounting for4.71%of the total, the preoperative diagnosis is: Bartholin’s abscess,Vulva black neviand the benign tumor of vulva.4. Campare the result of the preoperative biopsy with postoperativepathological, the accuracy of the pathological types and the differentiationdegree is better, respectively for93.58%and89.15%.5. The patient’s incision healing and length of stay in hospital is relatedwith the scope of the vulva surgery; With the same vulvar resect scope, thepostoperative incision recovery had no related with the inguinal lymphnodedissection, but the hospital day is ignificantly increased than those who onlyunderwent simple vulvectomy. 6. Histopathological classification(1) pathological types: VC ‘s main pathological types is squamous-celltype the proportions is (84.71%)， the proportions of vulvar malignantmelanoma is5.88%,Basal cell carcinoma is4.71%,Verrucous cell carcinoma is3.53%and Paget’s extramammary is1.18%.(2) clinical stage: among85VC patients30patients had FIGO stage I,41stage II,13stage III, and1stage IV disease.(3) The main clinical manifestations were vulvar pruritus(70.59%) andneoplasm(56.47%).Patients with lateral side lesions were62,and the linear sidelesions were23cases;3groups can be divided by the maximum diameter of thelesion:<2cm,2cm~5cm and>5cm,and the VC lesions were always between2~5cm.(4) Histology:among72squamous cell carcinoma cases,high medium andlow differentiated cases is respectively for57cases（79.17%）、11cases （15.28%）、4cases（5.56%）.(5) Lymph node involvement:51cases of inguinal lymph node resection,lymph node metastasis positive in11cases (21.57%). With the decline in thedegree of differentiation, lymph node metastasis gradually increased (χ2=8.53P=0.014<0.05).7. Anemia occurred after surgery or anemia increase is20(25.97%);29cases (37.66%) of poor healing incision,7cases(9.09%) of incisiondehiscence,.Lymphocele6(7.79%) cases, with conservative treatment, allcases’ lymphocele is absorbed.3cases of thrombotic disease (3.9%),allpatients are turned to the relevant departments and improved after all. Adhesionnarrow urethra in one case, accounting for1.30%of the surgery patients.Vaginal stenosis in3cases, accounting for3.90%of the surgery patients. 8. Follow-up: Prior to2009, the vast majority of patients lost the visit,andafter the year of2009, only30(35.29%) cases can be followed-up.Only24cases alive,3patients died of tumor recurrence and metastasis and3cases of73to88-year-old elderly patients died of poor general condition inpostoperative short-term.The shortest time of relapse after treatment is2months, the longest time is three years, the median time of recurrence is15months.7of30cases(23.33%) relapse.Conclusion1, The number of the patients is increased year by year, The trend of theonset ages of VC had been juvenescence and the Vulvar Cancer patients weremainly in rural.2, Patients combined with obesity, high blood pressure, diabetes wereincreased year after year; Malignant tumor history、gestation and obesity mayhave the positive correlation with VC onset. 3, Vulvar resect scope may has effect on the healing of incision. Vulvarhistopathologic grade is related with lymph node metastasis.