儿童颅内未成熟畸胎瘤的诊断及治疗（附36例报告）

Diagnosis and treatment on the intracranial immature teratomas in children （a report of 36 cases）

目的探讨儿童颅内未成熟畸胎瘤的诊断及治疗。方法2002年1月至2010年12月北京天坛医院神经外科收治40例颅内未成熟畸胎瘤患者，随访36例。对其临床症状、体征、血液中肿瘤标志物及影像学检查的结果等进行分析判断，明确未成熟畸胎瘤诊断后，根据肿瘤体积及患者的临床症状采取不同的治疗方式。结果36例均开颅手术，病理明确诊断为未成熟畸胎瘤。26例肿瘤直径〉3cm的患者根据临床表现及影像特点分为A、B二组。A组10例，临床症状较轻，影像表现周围浸润不明显，先行手术切除肿瘤，再行放化疗。B组16例，临床症状较重，先行化疗，待瘤体缩小，再手术，术后再化疗放疗。另10例瘤体〈3em的患者均先手术，然后化疗、放疗。结论颅内未成熟畸胎瘤应先化疗，待瘤体缩小并周围浸润局限后再行手术治疗，术后再化疗、放疗可明显延长患者的生存时间。

Objective To explore the diagnosis and combined treatments on the intracranial immature teratomas. Methods The clinical data of 40 intracranial immature teratomas were collected from Jan. 2002 to Dec. 2008, and 36 were followed up. According to the clinical symptoms, signs, serum tumor markers and radiology, the immature teratomas were diagnosed and the followed treated courses were different depending on the tumor volume and symptoms. Results All the 36 cases were operated and immature teratomas were confirmed by the histopathology. In the giant tumor group （26 cases, which the tumor diameter larger than 3 cm） , the cases were divided into group A and group B. In the group A, the patients were in a relative good condition and the tumors didn＇ t invade the adjacent cerebral tissues, so, the operation was recommended first and the chemo - and radio - therapy were followed. In the group B, when the patients were in a poor condition and tumors invade the adjacent cerebral tissues obviously, chemotherapy were recommended first and when the tumors shrink, the operations were followed and then treated by the combined treatments. In the small tumor group （10 cases, which the diameter less than 3 cm） , operations were recommended first and the combined treatments were followed. Conclusions Chemotherapy is firstly recommended on the intracranial immature teratomas, and when the tumors shrink and pseudo - membranes are formed, operations are followed. Postoperatively, combined treatments could obviously extend the patients＇ life.