37例颅内成熟及未成熟畸胎瘤治疗临床分析

The clinical study on the treatment of the introcranial mature teratoma and immature ter- atoma: 37 case reports

目的 探讨颅内成熟及未成熟畸眙瘤的有效治疗措施。方法 成熟畸胎瘤19例,未成熟畸胎瘤18例,37例患者均行开颅手术,其中成熟畸胎瘤全切除9例,近全切除2例,大部切除7例,活检1例,未成熟畸胎瘤全切除6例,近全切除6例,大部切除6例。全部诊断得到病理检查证实。首次治疗的患者出院时常规嘱放疗,其中成熟畸胎瘤4例未放疗。结果 成熟畸胎瘤随访14例.1例手术死亡,5例放疗后肿瘤复发,复发时间分别是4个月1例.半年2例,8月及2年各1例。这5例患者在二次手术后病理检查结果转变为未成熟畸胎瘤,并分别在第二次术后2个月～8个月之内死亡,5例死亡患者平均生存15个月。存活的8例患者中2例患者分别在第一次术后2年及4年肿瘤复发,并再次接受手术治疗。4例未行放疗。至随访时最长已生存4年6个月,最短1年1个月,平均已生存22个月。未成熟畸胎瘤随访16例,均行放疗,死亡15例。其中7例明确肿瘤复发,二次住院治疗。15例死亡患者平均生存17个月。结论 (1)为提高成熟及未成熟畸胎瘤的治疗效果,应尽量做到手术全切除肿瘤。 (2)提示病理科医师术中所见,建议多切片病理检查。(3)病理检查明确诊断为成熟畸胎瘤时,患者仍应定期复查CT或MRI.严密观察病情变化。(4)如病理检查结果明确为未成熟畸胎瘤,则应进行全方位治疗,即手术、放疗、化疗。

Objective To study the effective treatment of intracranial mature teratomas and immature teratomas. Methods In our series there were 19 cases of mature teratomas and 18 cases of immature teratomas. All patienes were treated surgically. The mature teratomas were totally removed in 9 eases, subtotally removed in 2 cases and partially removed in 7 cases, biopsy in one case. The immature teratomas were totally removed in 6 cases, subtotally removed in 6 cases and partially removed in 6 cases. All of the diagnosis were confirmed by histopathological examination. Results 14 patients with mature teratomas were follwed -up. One patient died as a result of radical surgery. Recurrency were found in 5 patients with mature teratomas and all of them received radiotherapy. Un fortunately. all of them died 2 to 8 months after second operation. The second result inhistopathological examination of these patients became immature teratomas. 8 patients with mature teratomas sitill lived .The average survival duration of these patients was 22 months. 16 patients with immature teratomas were also follwed-up. All of them received radiotherapy after operation. However. 15 patients died. The average survival duration was 17 months. Conclusion (1) The tumors total removal is demanded. ( 2) Attention must be drawed to the fact that histopathologic examinations should involve various positions and many sections inside the tumor. (3) The patients with mature teratomas are recommended to get re-examination of CT and MRI regularly so that the patient's condition can be observed closely. ( 4) The treatment methods of immature teratomas is combination of surgery. radiotherapy and chemotherapy.