Fiorica J V, Cavanagh D, Marsden D E, Shepherd J H, Ruffolo E H, Songster C L
Department of Obstetrics and Gynecology, University of South Florida Medical Center, Tampa.
South Med J. 1988 May;81(5):589-93. doi: 10.1097/00007611-198805000-00012.
We retrospectively studied 125 patients treated for carcinoma in situ of the vulva from 1961 through 1984, with follow-up ranging from one to 24 years. Patients' ages ranged from 24 to 90 years, with a mean age of 53 years. Multifocal disease was more common in women under age 40. Pruritus was the most common complaint, but 60% of the patients were asymptomatic. Twenty-five patients (20%) had other associated malignancies: carcinoma in situ of the cervix in ten patients, invasive carcinoma of the cervix in six, multifocal carcinoma in situ involving vulva, vagina, and cervix in five, vaginal carcinoma in situ in two, and endometrial carcinoma in two. Sixty-five patients were treated primarily with wide excision, 45 with total vulvectomy, seven with "subtotal" vulvectomy, three with skinning vulvectomy, and three with vulvectomy and bilateral groin node dissection; two patients refused treatment. Fifteen patients had a recurrence--recurrent carcinoma in situ in ten, and invasive carcinoma of the vulva in five. Whether the patient had had total vulvectomy or a lesser procedure appeared to make no difference in the recurrence rate. Thus a well planned excision of vulvar carcinoma in situ appears to be the treatment of choice. All recurrences were in patients over age 40, so although the lesion is histopathologically identical in the younger patients, its biologic behavior seems to be more benign. Since it is possible, however, that invasive disease will ultimately develop in some of the younger patients, careful follow-up is still required.
我们回顾性研究了1961年至1984年间接受外阴原位癌治疗的125例患者，随访时间为1至24年。患者年龄在24岁至90岁之间，平均年龄为53岁。多灶性疾病在40岁以下女性中更为常见。瘙痒是最常见的症状，但60%的患者无症状。25例患者（20%）患有其他相关恶性肿瘤：10例为宫颈原位癌，6例为宫颈浸润癌，5例为累及外阴、阴道和宫颈的多灶性原位癌，2例为阴道原位癌，2例为子宫内膜癌。65例患者主要接受广泛切除术，45例接受全外阴切除术，7例接受“次全”外阴切除术，3例接受剥脱性外阴切除术，3例接受外阴切除术及双侧腹股沟淋巴结清扫术；2例患者拒绝治疗。15例患者复发——10例为原位癌复发，5例为外阴浸润癌复发。患者接受全外阴切除术或较小手术似乎对复发率没有影响。因此，精心规划的外阴原位癌切除术似乎是首选治疗方法。所有复发患者均为40岁以上，所以尽管年轻患者的病变在组织病理学上相同，但其生物学行为似乎更良性。然而，由于一些年轻患者最终可能会发展为浸润性疾病，仍需要密切随访。
