72例卵巢恶性生殖细胞肿瘤病例回顾及保留生育功能治疗价值评估

发布时间：2018-04-19 07:45

  本文选题：卵巢恶性生殖细胞肿瘤 + 保留生育功能　； 参考：《山东大学》2017年硕士论文

【摘要】：目的:卵巢恶性生殖细胞肿瘤(Malignant Ovarian Germ Cell Tumors,MOGCT)在青少年等年轻女性中有着较高的发病率,随着近年来手术方式的提高改进和联合化疗的普及应用,MOGCT患者的生育及生存预后有了非常大的改善,本文经过分析72例MOGCT患者的临床特点,探讨影响MOGCT患者预后的因素,同时,评估保留生育功能的手术治疗对于该类患者获得较好妊娠结局的价值。方法:首先收集整理2005年1月-2016年6月间就诊于山东大学齐鲁医院的MOGCT患者的临床病例资料,然后进行电话随访,进而回顾性分析这部分患者的治疗和恢复情况。采用SPSS 22.0软件行统计学方面的分析,使用Kaplan-Meier法计算各亚组累积发病率,并绘制各亚组的生存曲线,用log-rank法对比生存曲线之间的差别,使用χ2检验和Fisher确切概率法对妊娠率进行分析。P0.05差异具有统计学意义。结果:1、在72例患者中,发病年龄范围为1岁1月-68岁,平均发病年龄为22.96±12.13岁,中位发病年龄为22岁。患者首次大多以腹胀或腹痛(48.6%)、腹部包块(27.8%)入院。术前接受血清CA-125检查的患者54例,其中升高的患者有36例(包括16例未成熟性畸胎瘤、12例内胚窦瘤);术前接受血清CA-199检查的患者35例,其中升高的患者有11例(其中包括9例未成熟性畸胎瘤);术前接受血清AFP检查的患者65例,其中升高的患者有40例(其中包括19例未成熟性畸胎瘤、18例内胚窦瘤)。2、72例患者中,除外外院手术无法明确具体分期者3例,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别有49、7、11、2例。其中Ⅰ期患者5年生存率达96.7%,而Ⅱ-Ⅳ期患者5年生存率为55.5%,差异具有显著性(P0.001);内胚窦瘤和非内胚窦瘤两组患者的五年生存率分别为60.2%、94.5%,差异具有统计学意义(P=0.006);对于同样伴有高危因素的部分患者,分为手术以后行辅助性化疗和未行辅助性化疗的两组,其5年生存率分别为88.6%、60.0%,具有显著性差异(P=0.035);而对于有无合并腹水及是否行全面分期手术的不同患者之间进行5年生存率比较,无显著性差异(P=0.226,P=0.562)。3、72例患者均接受手术治疗,根据是否接受保留生育功能手术,将全部患者分为两组,分别包括62、10例。其中接受保守手术的患者包括全面分期术16例、不全面分期手术25例、卵巢肿瘤剥除术15例以及单侧附件切除术6例。4、72例MOGCT患者中术后行辅助化疗者59人,疗程≤4次者23人,4疗程≤6次者18人,大多采用PEB方案(76.3%)化疗,部分儿童患者采用AVCP方案化疗。5、随访(6-137个月)结束时,6例复发,6例死亡,死亡时间为14-36个月。有生育计划的18人中,14例妊娠17次,足月分娩10次,流产6次,1例目前处于妊娠期。FIGO分期Ⅰ期、Ⅱ-Ⅳ期患者妊娠率分别为85.7%、25.0%,差异有统计学意义(P=0.044);不同手术方式、有无术后辅助化疗、病理类型之间妊娠率无显著性差异(P=0.268、P=0.268、P=0.326)。结论:1、MOGCT多发生于年轻女性,最为常见的临床症状有腹胀腹痛及盆腔包块,多伴有AFP等肿瘤标志物的升高;2、FIGO分期Ⅰ期患者预后明显好于Ⅱ-Ⅳ期患者;组织病理学类型为内胚窦瘤的患者预后比较差;术后辅助化疗对于改善患者的预后是有帮助的。3、对于年轻患者可保留生育功能手术,早期患者妊娠结局好于晚期患者,手术方式、病理类型及术后是否行辅助化疗对于妊娠结局无明显影响。
[Abstract]:Objective: malignant ovarian germ cell tumors (Malignant Ovarian Germ Cell Tumors, MOGCT) with teenagers and other young women in high incidence in recent years, with improvement of surgical methods and combined chemotherapy for the popularization and application of growth and survival prognosis of patients with MOGCT have a very big improvement, this paper through the analysis of clinical characteristics of 72 MOGCT patients, to explore the factors that affect the prognosis of patients with MOGCT at the same time, assessment of fertility preserving surgery for better pregnancy outcome of the value of this kind of patients. Methods: first collected in January 2005 -2016 year in June admitted to Qilu Hospital of Shandong University MOGCT patients with clinical data, and telephone follow-up, then review analysis this part of the patient's treatment and recovery. By the analysis of SPSS 22 software for statistics, use the Kaplan-Meier method to calculate each subgroup tired Product of incidence and survival curves of each subgroup, with comparison between log-rank survival curve difference, using 2 test and Fisher exact test were used for analysis of.P0.05 had significant difference on pregnancy rate. Results: 1 in 72 patients, the onset age range was 1 -68 in January, the average the age of onset was 22.96 + 12.13 years old, the median age was 22 years. For the first time in most of the patients with abdominal distension or abdominal pain (48.6%), abdominal mass (27.8%). 54 cases received preoperative admission serum CA-125 examination of patients, including patients with elevated in 36 cases (including 16 cases of immature teratoma, 12 cases endodermal sinus tumor; 35 cases) underwent preoperative serum CA-199 examination of patients, including patients with elevated in 11 cases (including 9 cases of immature teratoma); 65 cases underwent preoperative serum AFP examination of patients, including patients with elevated in 40 cases (including 19 cases of immature teratoma, 18 cases. Embryo).2,72 sinus aneurysm patients, except outside the hospital surgery can not be clear and specific stage in 3 cases, of which I, II, III, IV were 49,7,11,2 cases. The patients with stage I 5 year survival rate was 96.7%, while patients with II-IV period 5 year survival rate was 55.5%, the difference was significant (P0.001); endodermal sinus tumor and non endodermal sinus tumor in two groups of patients with five year survival rates were 60.2%, 94.5%, the difference was statistically significant (P=0.006); also for some patients with high risk factors, divided into two groups after surgery for adjuvant chemotherapy and received adjuvant chemotherapy, 5 years the survival rates were 88.6%, 60%, with a significant difference (P=0.035); and to have no ascites and whether the 5 year survival rate comparison between different patients underwent comprehensive staging surgery, there was no significant difference (P=0.226, P=0.562).3,72 patients underwent surgical treatment, according to whether or not to accept the reservation of fertility 鍔熻兘鎵嬫湳,灏嗗叏閮ㄦ偅鑰呭垎涓轰袱缁，

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