单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点和诊断治疗.docVIP

单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点和诊断治疗论文,... 单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点和诊断治疗 　　【摘要】　目的　总结单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点，探讨其正确的诊断和治疗方案。方法　采用回顾性分析方法，对18例肝脏周围复发的单纯性卵巢未成熟型畸胎瘤患者的临床分期、手术、化学治疗（化疗）以及其原发、复发肿瘤的病理，结合随诊结果进行综合分析。结果　本组患者平均发病年龄为24.8岁；初次手术的患者中，38.8%（7／18）的患者行单侧附件切除术，66.1%（11／18）为临床Ⅲ期，44.4%(8/18)肿瘤的病理分级为G1级；单纯性卵巢未成熟型畸胎瘤肝脏周围复发率为28.1%（18／64），其中初次手术后接受正规化疗患者的肝脏周围复发率为16.7%（3／18），未行正规化疗者的肝脏周围复发率为31.2%（15／48）；辅助诊断准确率较低；肝动脉插管化疗对控制肿瘤生长无效。单纯性卵巢未成熟型畸胎瘤肝脏周围复发患者随诊时间为3～205 个月(平均20.9个月),手术切除率为94.4%（17／18），转移瘤直径小于15 cm者手术后并发症少，患者3年生存率为77.8%(14/18), 失访率为0.0%(0/18)；5年生存率为55.6%(10/18), 失访率为22.2%(4/18); 10年生存率为38.9%(7/18), 失访率为38.9%(7/18)。患者最长生存时间已超过17年。结论　单纯性卵巢未成熟型畸胎瘤肝脏复发部位为肝脏周围表面，初次手术后正规化疗是预防单纯性卵巢未成熟型畸胎瘤肝脏周围复发的重要措施，但不能抑制其生长，肝动脉插管化疗的方法是错误的，适时手术可以减少并发症，改善患者预后。 　　The Characteristics Diagnosis and Treatment of Hepatic Metastasis of Simple Immature Ovarian Teratoma 　　【Abstract】　Objective　To analyze the characteristics of hepatic metastasis of pure immature ovarian teratoma and explore proper diagnosis and treatment. Methods　A total of 18 cases with hepatic metastasis of pure immature ovarian teratoma were involved in this study. The clinical stage, operation, chemotherapy and histopathology of primary and secondary tumor as well as the data of long term follow-up were analyzed retrospectivel y. Results　All of the hepatic metastatic tumor located on the surface of liver, 66.1%（11/18） of them was clinically stage 3 and 44.4% （8/18）was grade 1 at first operation. The hepatic metastatic rate was 16.7%（3/18） in standard adjuvant chemotherapy group but increased obviously to 31.2%（15/48） in irregular chemotherapy group. Auxiliary diagnostic methods could not indicate correct results. The surgical resection rate of hepatic metastasis of pure immature ovarian teratoma was 94.4%（17/18）. There was less complication occurred in the group with the diameter of tumor less than 15 cm. The follow-up time ranged from 3～205 months with the mean of 20.9 months. The 3 year survival rate was 77.8%