CAJ | 학술논문

目的：探讨小儿恶性生殖细胞肿瘤的综合治疗方法及治疗效果。方法：回顾性分析47例小儿恶性生殖细胞肿瘤患者的临床资料。47例患者以手术治疗为主要手段，在此基础上采用以PEB方案为主的正规化疗。化疗后注意处理化疗副作用，适当营养支持。结果：11例睾丸肿瘤，经过手术及正规化疗，AFP值恢复正常。随访观察5个月至5年，患者情况稳定。本组死亡5例：卵巢无性细胞瘤1例，骶尾部胚胎癌2例，纵膈胚胎癌1例，晚期内胚窦瘤1例。3例手术后复发进行了二次手术切除，并进行了较长时间的化疗。其余患者正在进行随访观察，生活状况接近一般儿童。结论：儿童恶性生殖细胞肿瘤发病率不高，但病理类型多样，危害性较大。约半数发生于生殖腺以外。AFP是术后观察恢复情况的重要指标。预后与发病部位、病理类型、肿瘤分期、是否完整的切除有关。在早期诊断、完整切除的基础上进行正规的化疗是提升治疗效果，提高生存率的关键。巨大肿瘤经过正规化疗，瘤体缩小后再行手术切除，同样有利于提高术后生存机会。
목적：탐토소인악성생식세포종류적종합치료방법급치료효과。방법：회고성분석47례소인악성생식세포종류환자적림상자료。47례환자이수술치료위주요수단，재차기출상채용이PEB방안위주적정규화료。화료후주의처이화료부작용，괄당영양지지。결과：11례고환종류，경과수술급정규화료，AFP치회복정상。수방관찰5개월지5년，환자정황은정。본조사망5례：란소무성세포류1례，저미부배태암2례，종격배태암1례，만기내배두류1례。3례수술후복발진행료이차수술절제，병진행료교장시간적화료。기여환자정재진행수방관찰，생활상황접근일반인동。결론：인동악성생식세포종류발병솔불고，단병리류형다양，위해성교대。약반수발생우생식선이외。AFP시술후관찰회복정황적중요지표。예후여발병부위、병리류형、종류분기、시부완정적절제유관。재조기진단、완정절제적기출상진행정규적화료시제승치료효과，제고생존솔적관건。거대종류경과정규화료，류체축소후재행수술절제，동양유리우제고술후생존궤회。
Objective :To summarize and analyze the biological characteristics ,comprehensive treatment , therapeutic effect and survival state of pediatric malignant germ cell tumor .Methods :Retrospectively analyzing the treatment and therapeutic effect of pediatric malignant germ cell tumor in 47 children who were treated in department of pediatric surgery ,the second hospital of Xi’an Jiaotong University .PEB regimen was used for the regular chemo-therapy on the basis of surgical operation .Pay attention to the side effect after chemotherapy ,and give proper nutri-tion .Results :After operation and regular chemotherapy ,AFP value of 11 patients with testicular neoplasm has re-turned to normal .During 5 months to 5 years follow-up ,all patients had good conditions except three children had AFP value elevation ,while had normal AFP after additional chemotherapy .5 patient died (1 case with dysgerminoma of ovary ,2 with sacral tail embryonal carcinoma ,1 patient mediastinum embryonal carcinoma ,1 with late endoder-mal sinus tumor) .3 patients underwent a second surgery due to recurrence and accepted long time chemotherapy .All survived patients are for long-term follow-up ,and found that their living conditions are similar with normal children . Conclusion :The incidence rate of pediatric malignant germ cell tumor is low ,while the pathological types are various and the perniciousness is huge .About half of them are not located in germ .The AFP value had important signifi-cance in the recovery after operation .Prognosis is associated with the pathogenic site ,pathological type ,neoplasm staging and whether resectting the tumor completely . On the basis of early diagnosis and complete resection of tumor ,regular chemotherapy is the key to improve the therapeutic effect and the survival rate .After regular chemo-therapy ,the size of giant tumor can be reduced ,and then the operation can be performed ,which may help to im-prove the survival rate .