CAJ | 학술논문

目的探讨卵巢成熟畸胎瘤恶变的临床特点、治疗方法及预后影响因素.方法对中国医学科学院北京协和医学院肿瘤医院1961年1月-2009年6月收治的44例卵巢成熟畸胎瘤恶变患者的临床病理资料进行回顾性分析.结果患者中位年龄48岁(16 ～ 84岁),平均肿瘤直径为(16±6)cm,卵巢成熟畸胎瘤恶变主要为鳞癌变,占73％(32/44)；术前行血清鳞状细胞癌抗原(SCC-Ag)水平检测的7例患者中有5例升高,术前行影像学检查的37例患者中仅3例(8％,3/37)提示为本病.44例患者均接受了手术治疗,术中8例患者接受了快速冰冻病理检查,其中5例经多点取材后发现恶变成分.44例患者中,肿瘤局限于一侧卵巢(即肿瘤无盆腹腔转移)者22例(其中包膜完整10例、包膜破裂12例),初治时肿瘤已发生了盆腹腔转移者22例,其中位总生存时间分别为126和10个月,两者比较,差异有统计学意义(P＜0.1).术后无肿瘤残留灶者27例,有肿瘤残留灶者17例,其中位总生存时间分别为84和10个月,两者比较,差异有统计学意义(P＜0.01).实施保留生育功能手术者7例,其中2例各有1次成功妊娠并顺产,此7例患者中6例术中发现包膜破裂,术后4例出现复发.结论卵巢成熟畸胎瘤恶变以鳞癌变最为常见,治疗以手术治疗为主,初治时肿瘤有盆腹腔转移、术后有肿瘤残留灶是影响患者预后的危险因素.有肿瘤包膜破裂的早期患者行保留生育功能手术应慎重.
목적 탐토란소성숙기태류악변적림상특점、치료방법급예후영향인소.방법 대중국의학과학원북경협화의학원종류의원1961년1월-2009년6월수치적44례란소성숙기태류악변환자적림상병리자료진행회고성분석.결과 환자중위년령48세(16 ～ 84세),평균종류직경위(16±6)cm,란소성숙기태류악변주요위린암변,점73％(32/44)；술전행혈청린상세포암항원(SCC-Ag)수평검측적7례환자중유5례승고,술전행영상학검사적37례환자중부3례(8％,3/37)제시위본병.44례환자균접수료수술치료,술중8례환자접수료쾌속빙동병리검사,기중5례경다점취재후발현악변성분.44례환자중,종류국한우일측란소(즉종류무분복강전이)자22례(기중포막완정10례、포막파렬12례),초치시종류이발생료분복강전이자22례,기중위총생존시간분별위126화10개월,량자비교,차이유통계학의의(P＜0.1).술후무종류잔류조자27례,유종류잔류조자17례,기중위총생존시간분별위84화10개월,량자비교,차이유통계학의의(P＜0.01).실시보류생육공능수술자7례,기중2례각유1차성공임신병순산,차7례환자중6례술중발현포막파렬,술후4례출현복발.결론 란소성숙기태류악변이린암변최위상견,치료이수술치료위주,초치시종류유분복강전이、술후유종류잔류조시영향환자예후적위험인소.유종류포막파렬적조기환자행보류생육공능수술응신중.
Objective To analyze the clinicopathologic characteristics,treatment and prognostic factors in malignant transformation of mature cystic teratoma(MCT)of ovary.Methods The clinical data of 44 patients with MCT from January 1961 to June 2009 were reviewed.Results The median age of the 44 patients was 48 years(range,16-84 years).Mean tumor size was(16 ±6)cm.Thirty-two cases were diagnosed squamous cell carcinoma(73％,32/44),and 5 of them with the elevated level of serumal squamous cell antigen(SCC-Ag).Three of 37 cases(8％,3/37)were identified with malignant transformation in image examinations.Rapid frozen section examination and multiple-location biopsy were performed in 8 cases,and 5 of them were detected with malignant diseases.Twenty-two patients with disease confined within the unilateral ovary(10 with intact capsule,and 12 with ruptured capsule).Diseases extended extra ovaries in the others 22 patients.The median cumulative overall survivals were 126 and 10 months,respectively.The difference between the two groups was significant(P ＜ 0.01).Twenty-seven patients had no residual tumor after primary surgery.The median cumulative overall survivals between the patients with and without residual tumor were 10 and 84 months respectively,and there were significant difference between two groups(P ＜ 0.01).Seven selected patients with malignant disease confined within unilateral ovary underwent fertility-sparing surgery,and 2 cases of them had successful pregnancies and delivery,while other 4 cases with ruptured capsule recurred.Conclusions The most common pathology type of malignant transformation in mature cystic teratoma of the ovary is squamous cell carcinoma.Comprehensive pre-operation image examination and tumor marker level detection might be of great help in diagnosis.Tumor extension extraovary and residual tumor after surgery are the most significant poor prognostic factors.Early stage patient with ruptured capsule should be very discreet to choose fertility-sparing surgery.