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.%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.
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