26例原发性纵隔恶性生殖细胞瘤的诊治

Diagnosis and Treatment of Primary Malignant Germ Cell Tumors of the Mediastinum

目的:探讨原发性纵隔恶性生殖细胞瘤的诊治及外科手术的作用。方法:对26例收治的原发性纵隔恶性生殖细胞瘤的临床资料进行回顾性分析。结果:22例手术治疗患者中,11例根治性切除,10例姑息性切除,1例探查,手术并发症发生率及死亡率分别为18.2%和9.1%,其中12例术后给予以顺铂为主的联合化疗,4例予以放疗。手术治疗患者术后病理为无性生殖细胞瘤12例,精原细胞瘤5例,未成熟畸胎瘤5例。3例未成熟畸胎瘤及1例胚胎癌患者明确诊断后未手术而给予放疗或放、化疗。本组26例患者中仅2例精原细胞瘤生存满5年,17例已证实死亡,除2例手术死亡外均死于肿瘤复发转移。结论:原发性纵隔恶性生殖细胞瘤的治疗应强调以化疗为主的综合治疗,外科切除只宜做为阶段性的辅助手段,手术时机把握应以具体患者情况而定。

Objective: To study the effective diagnosis and treatment of primary malignant germ cell tumors of the mediastinum and the role of operation. Methods: The clinical data of 26 patients with primary malignant germ cell tumors of the mediastinum were retrospectively analyzed. Results: Of the 22 patients with surgical treatment, 11 accepted radical tumor resection, 10 partial tumor resection and one only exploration. The operative morbidity and mortality rate was 18.2% and 9.1% respectively. 12 patients accepted cisplatin-based chemotherapy regimens and 4 received radiotherapy after operation. The pathologic diagnoses of 22 patients with surgical treatment were nonseminomatous malignant germ cell tumor 12 cases, seminoma 5 cases and immature teratoma 5 cases. Three patients with immature teratomas and one with embryonal carcinoma diagnosed by mediastinal scopic biopsy, lymph nods biopsy or transthoracic needle biopsy accepted radiotherapy or chemotherapy combined with radiotherapy. Of the 26 patients, only 2 survived longer than 5 years after operation. 17 patients were died of tumor relapse and distant metastases except 2 dead of operative complications. Conclusions: The treatment of primary malignant mediastinal germ cell tumors should emphasize combined therapy with chemotherapy as the main treatment. Surgical resection is only an adjuvant therapy for the appropriate phase of it. The opportunity of operation should depend on the patient`s situation.