Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies.
Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies.
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晚期和复发性外阴恶性肿瘤患者外阴重建的结果
DOI：
10.1186/s12885-015-1792-x
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发表时间：
2015-11-05
期刊：
影响因子：
3.8
通讯作者：
Shen K
中科院分区：
文献类型：
--
作者：
Zhang W;Zeng A;Yang J;Cao D;He X;Wang X;You Y;Chen J;Lang J;Shen K
背景皮瓣在外阴癌相关重建中的使用不断增加，但很少有研究评估手术后患者的结果和生活质量。本研究的目的是评估晚期和复发性外阴恶性肿瘤患者采用肌皮/皮瓣进行外阴重建的效果。方法对采用不同类型皮瓣进行外阴重建的外阴恶性肿瘤患者进行回顾性分析。以生活质量和预后为重点对患者进行评估。 结果 36例患者入组，其中58.33%的患者使用大腿前外侧皮瓣（ALT），16.67%的患者使用阴部大腿皮瓣（PTF），11.11%的患者使用腹壁深穿支（DIEP），2.78%的患者使用股薄肌皮瓣。患者中，其他 11.11% 的患者使用了两种类型的皮瓣。 11 名患者（30.56%）出现并发症，其中 5 名患者（13.89%）出现部分坏死，5 名患者（13.89%）出现轻微伤口裂开，1 名患者（2.78%）出现皮瓣蜂窝织炎。所有出现部分坏死的患者（13.89%）均接受了再次手术。重建前平均言语评定量表得分为1.44，术后平均言语评定量表得分为0.17（P<0.0001）。术前平均体能状态为 1.67，术后改善至 0.31（P< 0.0001）。外阴重建后的中位总体随访时间为 9 个月。 21 名患者 (58.3%) 在外阴重建后平均间隔 5 个月出现复发。中位随访时间为 14 个月后，41.7% 的患者还活着并且没有疾病。 36 名患者的 5 年生存率为 53.8%。 结论 接受晚期/复发性外阴恶性肿瘤切除术的患者进行软组织重建与术后并发症发生率低、疼痛减轻和功能状态改善相关。尽管该患者群体的复发率很高，但接受晚期/复发性外阴癌切除和重建手术的患者中有相当比例似乎受益。
BackgroundThe use of flaps in vulvar cancer-related reconstruction has been increasing, but few studies have evaluated the outcome and quality of life of patients after this surgery. The purpose of this study was to evaluate the outcomes of vulvar reconstruction using musculocutaneous/skin flaps in patients with advanced and recurrent vulvar malignancies.MethodsPatients with vulvar malignancies who underwent vulvar reconstruction using different types of flaps were retrospectively reviewed. Patient outcomes were evaluated with a focus on quality of life and prognosis.ResultsThirty-six patients were enrolled, 58.33 % of them used anterolateral thigh flap (ALT), 16.67 % of them used pudendal thigh flap (PTF), 11.11 % of them used deep omferior epigastric perforator (DIEP) and gracilis myocutaneous flap were used in 2.78 % of the patients, the other 11.11 % patients used two types of flaps. Eleven patients (30.56 %) developed complications, including 5 patients (13.89 %) with partial necrosis, 5 (13.89 %) with minimal wound dehiscence and 1 (2.78 %) with flap cellulitis. All patients who developed partial necrosis (13.89 %) underwent reoperation. The mean verbal rating scale score was 1.44 before reconstruction and 0.17 after surgery (P< 0.0001). The mean performance status was 1.67 before surgery and improved to 0.31 after surgery (P< 0.0001). The median overall follow-up time after vulvar reconstruction was 9 months. Twenty-one patients (58.3 %) developed recurrence at a median interval of 5 months after vulvar reconstruction. After a median follow-up time of 14 months, 41.7 % of the patients were living and disease-free. The 5-year survival of the 36 patients was 53.8 %.ConclusionSoft tissue reconstruction in patients undergoing resection of advanced/recurrent vulvar malignances is associated with a low rate of postoperative complications, decreased pain, and improved functional status. Although the recurrence rate in this patient population is high, a reasonable proportion of patients who undergo resection for advanced/recurrent vulvar cancer and reconstructive surgery appear to benefit.