卵巢恶性畸胎瘤20例诊治分析

Clinical Analysis of 20 Cases with Malignant Ovarian Teratoma

目的探讨卵巢恶性畸胎瘤的临床病理特点及诊治方法。方法对笔者所在医院1997年5月-2012年5月收治的20例卵巢恶性畸胎瘤患者的临床资料进行回顾性分析。结果（1）诊断：成熟畸胎瘤恶变（MT）12例，未成熟畸胎瘤（IM）8例。（2）临床特征：患者年龄16-67岁，9例MT≥50岁（75％），6例IM≤20岁（75％）；肿块直径≥10cm有18例（90％），以囊实性包块为主，部分可探及血流信号；MT多见CA125或CA199升高，IM多见CA125、CEA或AFP升高。（3）治疗及随访：20例均行手术治疗，二次手术6例，保留生育功能手术8例；术中冷冻病理18例，误诊4例；术后化疗12例，放疗2例。术后随访18例，其中2例复发，3例死亡，14例无瘤生存至今。结论疑为卵巢畸胎瘤患者，年龄（≥50岁或≤20岁）、肿块直径≥10cm、血清肿瘤标志物指标升高和腹腔积液是恶性的信号，应尽早手术，送术中冷冻病理，如恶性应术后及时化疗，降低复发率，提高患者生存率。

Objective To analyze the clinicopathological characteristics, treatment and prognosis of ovarian malignant teratomas. Methods The clinical data of 20 cases malignant ovarian teratoma who were diagnosed from May 1997 to May 2012 in the hospital were analyzed retrospectively. Results （ I ） Diagnosis： twelve cases were diagnosed as malignant transformation of mature cystic teratoma （MT） , and eight cases were diagnosed as immature teratoma（IM）. （2） Clinical features： the age ranged from sixteen to sixty - seven years;nine patients were older than or equal to fifty years old in MT group（75% ） , while six patients were younger than or equal to twenty years old in IM group（75% ） ; the diameter of tumor larger than or equal to ten centimeter were available in eighteen cases （90%） ;the majority of them were cystic masses and blood flow signals could be detected partly;elevated CA125 or CA199 were common in MT group, while elevated CA125, CEA or AFP in IM group. （3）Treatment and follow -up： all patients underwent surgery;meantime six patients had a second surgery and eight patients had fertility - sparing surgery;iutra - operative frozen pathologies were send in eighteen cases and four cases were misdiagnosed;twelve patients had postoperative chemotherapy and two had radiotherapy;postoperative follow -up were a- vailable in eighteen cases, including two patients of recurrence, three patients of disease - related death and fourteen patients of disease - free survival. Conclusion Patients with suspected ovarian teratoma, age older than fifty years or younger than twenty years, tumor diam- eter larger than ten centimeter, elevated serum tumor markers indicators and ascites are signals of malignant. Operate as soon as possible, send intra - operative frozen pathology, and have chemotherapy timely if malignant is the approach to reduce the relapse rate and improve the survival rate.