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卵巢未成熟畸胎瘤的临床病理特点及治疗方式

Clinical-pathological characteristics and treatment of ovarian immature teratoma

  • 摘要: 目的:探讨卵巢未成熟畸胎瘤的临床病理特点以及不同手术方式(卵巢肿块剥除术、附件切除术、全子宫+双附件切除术)对其预后的影响,分析卵巢肿块剥除术用于临床明显早期卵巢未成熟畸胎瘤的可行性。方法:回顾性分析1997年7月至2015年8月在复旦大学附属妇产科医院诊治并经病理证实的50例卵巢未成熟畸胎瘤患者的临床资料,依据手术方式分为3组。比较各组患者的临床病理特点及预后情况。结果:50例患者无失访,随访时间3~207个月。FIGO分期:ⅠA期34例,ⅠC1期10例,ⅠC2期3例,ⅡB、ⅢB、ⅢC各1例。卵巢肿块剥除术组、患侧附件切除术组、全子宫+双侧附件切除术组5年无病生存率分别是100%、86.8%、100%。行保留生育功能手术的45例患者中,明显早期患者42例。50例患者中无病死,总的5年无病生存率为91.0%。50例患者中,复发4例,复发后3例患者接受补充手术治疗、1例接受辅助化疗,再次手术患者的术后病理提示复发病灶为成熟畸胎瘤。45例保留生育功能手术的患者中,44例月经恢复正常,仅1例术后月经周期缩短。术后有生育要求的患者共13例,其中11例患者成功受孕并正常分娩,2例患者至研究末期未孕(1例因输卵管因素、1例原因不明)。结论:卵巢未成熟畸胎瘤初次治疗时多为早期,对局限于卵巢的明显早期的未成熟畸胎瘤患者可行卵巢肿块剥除术,术后根据病理分级选择化疗方案。

     

    Abstract: Objective:To investigate the clinicalpathological characteristics of ovarian immature teratoma and the effects of different surgery methods (cystectomy, salpingooophorectomy and hysterectomy+ bilateral salpingooophorectomy) on the prognosis of the patients and to analyze the role of cystectomy for apparent earlystage ovarian immature teratoma. Methods:Clinical data of 50 patients who were pathologically diagnosed with immature teratoma between Jul. 1997 and Aug. 2015 at the Obstetrics and Gynecology Hospital of Fudan University were analyzed retrospectively. According to the surgery methods, these patients were divided into three groups. The clinicalpathological characteristics and the prognosis of disease were compared. Results:All 50 cases were participated in the study. The followup time was 3207 months. FIGO stage as follows:ⅠA (34 patients), ⅠC1(10 patients), ⅠC2 (3 patients) and ⅡB, ⅢB and ⅢC (1 patient). Patients were divided into cystectomy group, salpingooophorectomy group and hysterectomy and bilateral salpingooophorectomy group. The five year diseasefree survival (DFS) was 100%,86.8%,100%, respectively. There were 45 patients underwent fertilitysparing surgery, 42 patients were the apparently early stage. No patient died among 50 cases, the total five year DFS rate was 91.0%.Among 50 cases, 4 cases were relapsed, and 3 cases had supplement surgery, 1 case was received assisted treatment, the postoperative pathology indicated that the recurrence was mature teratoma. Among 45 cases, 44 cases had normal period, only 1 case has shorten the period time. There were 13 patients with fertility requirements after surgery, including 11 cases of successful pregnant,and delivered 11 healthy infants, 2 cases were infertility (1 case due to tubal factor, 1 case of unexplained). Conclusions:Majority of patients are diagnosed with ovarian immature teratoma at an early stage. The data suggested that cystectomy could be considered for apparent earlystage patients affected by pure immature teratoma without adverse impact upon survival. Chemotherapy regimen is determined by pathological grade.

     

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