卵巢卵黄囊瘤9例临床分析

Clinical Analysis of 9 Cases of Ovarian Yolk Sac Tumor

目的:探讨卵巢卵黄囊瘤(ovarian yolk sac tumor, OYST)这一罕见疾病的诊断、治疗及预后。方法:对天津市中心妇产科医院2004年10月至2014年10月收治并经过手术和病理诊断确诊的9例OYST患者的临床资料进行分析、探讨和总结。结果:9例患者年龄17~60岁,中位年龄21岁。出现腹痛症状的患者5例,其余4例患者出现不同程度腹部坠胀现象,早期患者(6例IC期)占66.7%,晚期患者(1例IIIA期,2例IIIC期)占33.3%。手术前所有患者甲胎蛋白(alpha-fetoprotein,AFP)水平均高于正常值,对9例患者均施行手术治疗,对提出保留生育功能8例患者行保留生育功能手术方案,其中2例患者术后肿瘤未控,再次行根治性肿瘤细胞减灭术。1例绝经期患者直接行根治性手术。术后所有患者均采用BEP[博来霉素(bleomycin)、依托泊苷(etoposide)、顺铂(platinol)]方案进行辅助化疗,2例再次肿瘤细胞减灭术患者因AFP下降不满意,其中1例改为IEP[异环磷酰胺(ifosfamide)、依托泊苷(etoposide)、顺铂(platinol)]方案化疗,另1例改为VeIP方案化疗[长春新碱(vinblastine)、异环磷酰胺(ifosfamide)、顺铂(platinol)]。中位随访时间132月(80~178月),1例IIIA期患者死亡,2例IIIC期及6例IC期患者均无瘤生存,接受保留生育功能手术的6例患者中3例已正常生育。结论:卵巢卵黄囊瘤是一种来源于原始生殖细胞的高度恶性生殖细胞肿瘤,发病率极低,多见于低年龄的女性。血清AFP作为一种特异性较高的OYST标志物,对OYST的诊断具有肯定的价值。OYST对化疗非常敏感,对提出保留生育功能的患者在术中采取相应术式,术后可采用合理的BEP方案进行辅助化疗。

Objective:To investigate the diagnosis,treatment and prognosis of a rare disease,ovarian yolk sac tumor(OYST).Methods:The clinical data of 9 patients with OYST admitted to Tianjin Central Hospital of Gynecology and Obstetrics from October 2004 to October 2014 were collected,a retrospective analysis was made and a conclusion was drawn.Results:The 9 patients were 17-60 year olds,and the median age was 21 years.Five patients had abdominal pain and 4 patients had abdominal distension.Six patients(66.7%)were in an early stage(IC),3 patients(33.3%)were in the late stages(one case in stage IIIA,two cases in stage IIIC).The preoperative alpha-fetoprotein(AFP)level of all patients was in an above-normal level.All patients underwent surgeries,and those for 8 patients were adjusted as their demand for fertility preservation.The tumor of 2 patients was not controlled after operation,and they underwent cytoreductive surgery.One menopausal patient underwent radical surgery.All patients received chemotherapy with bleomycin,etoposide and platinol(know as the BEP regimen)after operation.The AFP of 2 patients did not decrease to a satisfactory level after the second cytoreductive surgery.One patient thus received chemotherapy with ifosfamide,etoposide and platinol(know as the IEP regi-men),and the other received chemotherapy with vinblastine,ifosfamide and platinol(know as the VeIP regimen).The median follow-up time was 132(80-178)months.One patient with stage IIIA OYST died.Two patients with stage IIIC OYST and 6 patients with stage IC OYST had tumorfree survival.Three of the 6 patients with fertility-sparing surgery achieved fertility preservation.Conclusion:OYST is an ovarian malignancy originating from genital cells.It is relatively common in young women with low incidence.Serum AFP,as a OYST marker with high specificity,is of positive value in the diagnosis of OYST.OYST is highly sensitive to chemotherapy.Fertility-sparing surgery is adopted for patients with demand for fertility preservation,and BEP regimen is used for adjuvant chemotherapy after operation.