新生儿骶尾部畸胎瘤的诊治

Diagnosis And Therapy of Neonatal Sacrococcygeal Teratoma

目的总结新生儿骶尾部畸胎瘤的临床特点,探讨术前后检测血清AFP对判断畸胎瘤的良恶性是否有意义。方法自1988年12月～2004年1月共诊治新生儿骶尾部畸胎瘤25例,对临床表现、辅助检查、手术及病理等进行详细分析。结果本组25例中,年龄0～10d者16例,11～20d者5例,21～30d者4例。其中6例尿潴留,1例大便潴留伴发低位肠梗阻。囊性8例,实性4例,混合性13例,多数呈哑铃型。11例X线平片见骶尾部有边界较清楚肿物,偶见条状或斑块状钙化。9例术前MRI检查,可见低信号或混杂信号,个别者有钙化影。9例三维彩超见骶尾部及盆腔内囊实混合性肿物。术前用电化学发光法检测血清甲胎蛋白(AFP)15例,其中AFP≥400Iu/ml13例,2例<400Iu/ml。出院复查AFP<400Iu/ml10例,AFP≥400Iu/ml5例。出院后1～4个月复查AFP正常。全部病例出院。病理:成熟型畸胎瘤18例,未成熟型畸胎瘤6例,恶性小圆细胞性肿瘤1例。结论新生儿骶尾部畸胎瘤绝大多数为良性,混合型居多,早期以尿便障碍就诊。经骶尾部切口可完整切除肿瘤,无副损伤,预后良好。术前后检测血清甲胎蛋白(AFP),有一定参考意义,可作为畸胎瘤随访的客观指标。

Objective To study the clinical features of neonatal sacrococcygeal teratoma (SCT) and explore the diagnastic value of alpha-fetoprotein assay to the disease. Methods Twenty-five neonates with sacrococcygeal teratoma were treated in our hospital between December 1988 and January 2004. There were 9 males and 16 females,age ranged from 2 hours to 30 days. We retrospectively analyzed their records of clinical presentation,investigation,surgery,and histopathology. Results Of the 25 neonates,there were 16 babies age ranged from 0 to 10 days,5 babies age ranged from 11 to 20 days,4 babies age ranged from 21 to 30 days. 6 patients had urinary obstruction and one had bowel obstruction. Of these tumors,8 were cystic,4 were solid,13 were mixture and most of them were dumbbell-shaped. Imaging studies included radiography,abdominal ultrasound,and magnetic resonance imaging. X-ray films was done in 11 patients and showed obvious masses in the sacrococcygeal region . Magnetic resonance imaging (MRI) was done in 9 patients and showed low or mixture signals. Abdominal ultrasound was done in 9 patients and revealed partly cystic and partly solid masses in the sacrococcygeal region and pelvis. Preoperatively,Alpha-fetoprotein (AFP) assay was used in 15 patients and revealed AFP≥400 Iu/ml in 13patients,<400 Iu/ml in 2 patients. The 15 patients were determined postoperatively again and showed AFP<400 Iu/ml in 10 patients,AFP≥400 Iu/ml in 5 patients. From 1 to 4 months AFP in all patients recovery to normal range after operation. All cases were cured in our group. Of the 25 patients there were 18 mature teratomas,6 immature teratomas,and 1 malignant small round cell tumor. Conclusions Most neonatal sacrococcygeal teratomas were benign and mixture. Some patients may complaint about urinary/bowel obstruction in early period. The tumors can be removed via the sacrococcygeal route and the prognosis was favorable. The routine use of AFP assay preoperatively and postoperatively may be helpful to predict the outcome of the disease.