卵巢肿瘤剔除术用于恶性生殖细胞肿瘤的临床结局

Clinical Outcome of Cystectomy for Malignant Ovarian Germ Cell Tumor

目的回顾性评价恶性生殖细胞肿瘤患者卵巢肿瘤剔除术的临床结局。方法 回顾1980年1月至2010年12月255例就诊于北京协和医院、病理诊断为恶性生殖细胞肿瘤患者的临床资料,对其中21例(8%)初次手术为卵巢肿瘤剔除术患者的疗效进行分析。结果 21例恶性生殖细胞肿瘤患者中,15例(71%)诊断为未成熟畸胎瘤(I级9例,I～II级3例,II级3例),1例卵黄囊瘤,4例无性细胞肿瘤,1例混合生殖细胞肿瘤。术后除3例(未成熟畸胎瘤I级2例,I～II级1例)患者外,其余18例患者均进行了化疗,所有患者随访中位时间为52个月(9～178个月),随访期间除1例混合生殖细胞肿瘤患者术后8个月右卵巢肿瘤复发外,其余均未复发。2例患者(无性细胞瘤1例,未成熟畸胎瘤1例)术后成功妊娠,并分娩足月健康新生儿。结论在严密随访下,对早期无性细胞肿瘤、未成熟畸胎瘤,甚至卵黄囊瘤患者进行肿瘤剔除术结合必要的化疗能取得满意的治疗效果,但需要进行更大样本的研究证实单纯肿瘤剔除术对生殖细胞肿瘤患者的痊愈足够有效。

Objective To evaluate the clinical outcome of patients who underwent cystectomy only as part of their surgical treatment for malignant ovarian germ cell tumor（MOGCT）.Methods Totally 255 MOGCT patients were diagnosed and treated in our department between January 1980 to December 2010.Among them 21 patients underwent cystectomy only as their initial surgery.These 21 patients entered the final analysis.Results Of these 21 MOGCT patients,15 were with immature teratoma [Grade 1,n=9;grade 1-2,n=4;grade 2,n=2）,one with yolk sac tumor,four with dysgerminoma,and one with mixed germ cell tumor.All except three patients（two with grade 1 and one with grade 1-2 disease）received adjuvant chemotherapy.All patients were followed up,with a median duration of 52 months.No recurrence was observed during this period except one patient experienced mixed germ cell tumor.Two patients（one with dysgeminoma and one with immature teratoma）successfully became pregnant and delivered healthy babies.Conclusions Cystectomy followed by adjuvant chemotherapy can achieve satisfactory effectiveness for apparent early-stage immature teratoma,dysgerminoma,and even yolk sac tumor under close follow-up.However,studies with larger samples are required to confirm whether cystectomy alone is enough for curing MOGCT.