纵隔原发性精原细胞瘤二例并国内三十年临床病例资料文献复习

发布时间：2018-04-20 09:27

本文选题：精原细胞瘤 + 纵隔肿瘤　；参考：《中国全科医学》2017年24期

【摘要】：目的分析纵隔原发性精原细胞瘤的临床特点、影像学表现及病理表现、治疗及转归等,以期为临床提供参考,提高医生对该病的认识。方法系统查阅"CNKI、维普网、万方数据知识服务平台"数据库,以"纵隔精原细胞瘤"为关键词对1979年1月—2016年7月发表的中文文献进行检索,通过去重,删除资料不完整等文献后,共纳入资料完整文献59篇,共75例患者,加上本文报道的2例共77例患者。分析其临床表现、确诊方式、影像学表现、病理表现、治疗及预后等资料。结果77例患者主要为男性(96.1%,74/77),最常见临床症状是胸痛(37.7%,29/77),其次为胸闷(31.2%,24/77);主要的确诊方式是开胸探查术+术后病理检查(80.5%,62/77);影像学表现为纵隔不规则团块影,密度不均匀;增强扫描大部分不均匀强化;病灶位置主要位于前纵隔。病理表现为大部分病灶呈分叶状肿物;光镜下可见成团分布的圆形细胞,瘤细胞呈弥漫片状生长,异形性明显。最常用治疗方法是手术结合放化疗,早期疗效较好,总治愈率为82.4%,总有效率为90.2%,病死率为9.8%,患者死亡的主要原因为全身多处转移。结论纵隔原发性精原细胞瘤临床少见,多见于青年男性,好发于前纵隔,对放化疗敏感,治疗可手术联合放化疗,早期预后良好,多可治愈。
[Abstract]:Objective to analyze the clinical features, imaging and pathological manifestations, treatment and prognosis of primary seminoma of the mediastinum in order to provide reference for clinical practice and improve the understanding of the disease. Methods the database of "CNKI, Wei-Pu, Wanfang data knowledge Service platform" was consulted systematically, and the Chinese literature published from January 1979 to July 2016 was searched with "mediastinal spermatogonoma" as the key word. After the incomplete data were deleted, a total of 59 articles (75 cases) were included, plus 2 cases (77 cases) reported in this paper. The clinical manifestations, diagnostic methods, imaging findings, pathological findings, treatment and prognosis were analyzed. Results the most common clinical symptoms of 77 patients were 96.1% 74 / 77, and the most common clinical symptoms were chest pain, 37.7% and 29 / 77, followed by chest tightness, 31.2% and 24 / 77, respectively. The main way of diagnosis was the pathological examination of 80.5% / 77% after thoracotomy, and the imaging manifestation was irregular mass of mediastinum with uneven density. Most of the contrast-enhanced scans showed uneven enhancement, and the location of the lesions was mainly located in the anterior mediastinum. Histopathological findings showed that most of the lesions were lobulated and round cells were found in clusters under light microscope. The tumor cells grew in diffuse flake shape and had obvious heteromorphism. The most commonly used treatment was surgery combined with radiotherapy and chemotherapy. The early curative effect was better, the total cure rate was 82.4%, the total effective rate was 90.2 and the mortality was 9.8%. The main cause of death was multiple metastases throughout the body. Conclusion Primary seminoma of mediastinum is rare in clinic, mostly seen in young men. It is easy to occur in anterior mediastinum and is sensitive to radiotherapy and chemotherapy. It can be treated with surgery combined with radiotherapy and chemotherapy. The early prognosis is good and most of them can be cured.
【作者单位】：遵义医学院第三附属医院(遵义市第一人民医院)呼吸内科;遵义医学院附属医院呼吸内科;广西医科大学第一附属医院呼吸内科;
【分类号】：R734.5

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