新生儿骶尾部畸胎瘤病理与治疗探讨

Sacrococcygeal Teratoma in Neonatal: Pathology and Therapy

目的 :分析新生儿骶尾部畸胎瘤的病理特点并探讨治疗要点。方法 :回顾分析 1990～ 2 0 0 3年间复旦大学附属儿科医院收治新生儿骶尾部畸胎瘤共 2 8例 ,手术标本送常规病理检验。结果 :男性 10例 ,女性 18例。I型 10例 ,II型 14例 ,III型 4例 ,瘤体在 10cm以上者 5例 ,其中 3例为巨大。平均手术年龄在 2 9± 2 2 .36d ,均在术中切除尾骨。 17例手术不需输血 ,其余输血 5 0～ 5 0 0ml不等。术后伤口感染 10例 (35 .71% )。术后病理 :良性 2 6例 ,其中含成熟神经组织 14例 ,恶性 3例 ,其中均含有未成熟神经组织。 2例良性畸胎瘤术后 1年复发 ,其中 1例复发为恶性。结论 :良性骶尾部畸胎瘤中 ,含神经组织成分可能是良性骶尾部畸胎瘤复发的危险因素之一。对新生儿巨大骶尾部畸胎瘤 ,术中控制髂内动脉 ,手术安全、术中出血少。瘤体的切除而影响了近肛门部皮瓣的血供可能是导致骶尾部畸胎瘤切口易感染的原因。

Objective: To study the pathology and therapy characteristics of of neonatal sacrococcygeal teratoma. Methods: A retrospective study was carried out on the records of 28 infants with sacrococcygeal teratoma in our hospital.All excised tissues were examined pathologically. Results: Eighteen (64.29%) patients were females and ten patients were males. The majority (85.71%) of the tumors were Altman classification I and II. Five tumors' diameter were larger than 10cm. The initial surgical removal of the SCT (including the coccyx) was carried out at 29±22.36 days of live. Seventeen cases needed not blood transfusion while other needed 50～500ml transfusion. The wound infection happened in 10 patient(35.71%). There were 26 benign teratomas after the pathological examine, and 14 cases have matured nerve tissues. Three were reported as malignant tumors with immatured nerve tissues. There were 2 initially reported benign tumors recurred after one year and one was malignant recurrence. Conclusion:Nerve tissues which contanted in the tumor may be a factor to indicate the recurrence of benign SCT. For those huge SCT, controlling the internal iliac artery can made the operation safer. The removal of the tumor may cut the blood supply of the wound and cause the infection. The occult spinal bifida concomitant with SCT may be the major cause of anus dysfunction.