卵巢恶性生殖细胞肿瘤31例临床分析

A Clinical Analysis of 31 Cases with Ovarian Malignant Germ Cell Tumor

[目的]探讨改善卵巢恶性生殖细胞肿瘤疗效、提高生存质量的方法。[方法]回顾1994年～1997年治疗的恶性生殖细胞肿瘤31例,分析其疗效以及影响预后的因素。[结果]Ⅰ期20例、Ⅱ期2例、Ⅲ期8例、Ⅳ期1例。病理类型:未成熟畸胎瘤9例、无性细胞瘤9例、混合性生殖细胞瘤7例、内胚窦瘤5例、胚胎癌1例。患侧附件切除13例,全子宫+双附件+大网膜+阑尾切除16例,2例因无法减瘤仅行探查活检。31例术后均接受以铂类药物为基础的腹腔化疗2～3次,继以全身化疗3～6个疗程。全组23例无瘤生存5年以上。早期病例生存率较晚期高(P=0.004)。无性细胞瘤、混合性生殖细胞瘤及未成熟畸胎瘤预后较内胚窦瘤和胚胎癌好(P<0.05)。Ⅰ期13例单纯附件切除组5年生存12例,7例行根治术组5年生存6例,差异无显著性(P>0.05)。[结论]临床分期是最重要的预后因素,早期病例完全可行患侧附件切除术。

To investigate the ways to improve response and th e qualit y of life in patients with ovar-ian malignant germ cell tumor.Thirty-one cases with histologically comfirmed ovarian malignant germ cell tumor from19 94to1997were analyzed retrospectively.According to the FIGO staging20, 2,8and1cases were in stageⅠ,Ⅱ,ⅢandⅣ,respectively.The histopathologic types in the series were immature teratoma(n=9),dysgerminoma(n=9),mixed germ cell tu mor(n=7),endodermal sinus tumor(n=5)and enbryonal carcinoma(n=1).Thirteen cases underwent unilateral salpingo-oophorectomy;16,to-tal hysterectomy with bilatera l salpingo-oophorectomy and omentectomy;2,laparotomy biopsy.All31cases received postoperative combination chemotherapy(BEP or VAC).Twenty-three of31cases ar e alive with no evidence of disease at the5-year follow-up period.Twelve of13c ases with stageⅠtreated by unilater-al salpingo-oophorectomy were alive,where as1of7cases treated by radical surgery died in5years.There was no significant di fference for survival rate in two groups(P>0.05).FIGO staging and pathological t ype were two important prognositic factors.[Conclusion]FIGO staging is an import ant prognostic factor.Unilateral is feasibility for patients with early stage tu mor who wishs to preserve fertility.