Durdević S, Hadzić B, Petrović D
Klinika za ginekologiju i akuserstvo, Klinicki centar, Novi Sad.
Med Pregl. 2000 Nov-Dec;53(11-12):607-12.
Vulvar carcinomas comprise almost 5% of all malignant tumors of the female genital tract. The final diagnosis is made after histologic examination of biopsy specimens obtained from different sites in the vulva. Primary therapeutic approach in all cases is surgery, whereas the operative procedure depends on the size and location of the lesion, stage of the disease, general condition and age of the patient, as well as on the condition of the surrounding tissue and possible continuance of sexual life.
In the period from 1985-1999, there were 39 patients with invasive forms of vulvar carcinomas operated at the Department of Gynaecology in Novi Sad. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in 26 (66.6%) patients. During 1994, a wide "butterfly-shaped "block" dissection of the vulva, pubis and inguinal area was done, whereas during the following period, the operative area was reduced by application of separate inguinal incisions after Hacker, leaving the tissue bridge in between.
The mean age of operated patients was 62.1 years (34-85). There were 53.8% stage I, 17.9% stage II, 20.7% stage III and 7.6% stage IV patients. In patients undergoing radical surgery the average number of extirpated lymph nodes was 16.3 out of which in 7 (26.9%) cases the nodes were positive. Lethal outcome was recorded in 4 (15.3%) patients. Two (7.6%) died of pulmonary thromboembolism and 2 (7.6%) during the following 5 years for diffuse dissemination of metastases. During 1994, complications were recorded in 69.2% operated patients versus 7.6% recorded during the following period.
Radical vulvectomy associated with bilateral inguinal-femoral lymphadenectomy is a standard procedure in surgical treatment of invasive stages of vulvar carcinoma protruding more than 1 mm. The application of two separate inguinal incisions after Hacker resulted in shortening the intrahospital postoperative period from 34.2 to 14 days and reduction of the rate of wound dehiscence and postoperative complications in the period following 1994.
外阴癌约占女性生殖道所有恶性肿瘤的5%。最终诊断需在对外阴不同部位获取的活检标本进行组织学检查后做出。所有病例的主要治疗方法是手术，而手术方式取决于病变的大小和位置、疾病分期、患者的一般状况和年龄，以及周围组织的情况和性生活的可能性。
1985年至1999年期间，诺维萨德妇科有39例浸润性外阴癌患者接受了手术。26例（66.6%）患者进行了根治性外阴切除术联合腹股沟股淋巴结清扫术。1994年，对外阴、耻骨和腹股沟区域进行了广泛的“蝴蝶形”整块切除，而在随后的时期，采用了哈克（Hacker）提出的单独腹股沟切口，缩小了手术范围，保留了其间的组织桥。
手术患者的平均年龄为62.1岁（34 - 85岁）。I期患者占53.8%，II期患者占17.9%，III期患者占20.7%，IV期患者占7.6%。接受根治性手术的患者平均切除淋巴结数为16.3个，其中7例（26.9%）淋巴结呈阳性。4例（15.3%）患者死亡。2例（7.6%）死于肺血栓栓塞，2例（7.6%）在随后5年内因转移灶弥漫性扩散死亡。1994年，69.2%的手术患者出现并发症，而在随后时期这一比例为7.6%。
根治性外阴切除术联合双侧腹股沟股淋巴结清扫术是治疗突出超过1毫米的浸润性外阴癌的标准手术方法。1994年后采用哈克提出的两个单独腹股沟切口缩短了住院术后时间，从34.2天降至14天，并降低了伤口裂开率和术后并发症发生率。
