目的 探讨有生育要求的卵巢恶性生殖细胞肿瘤(MOGCT)初治患者的手术治疗方式及疗效.方法 收集1992-2010年中国医学科学院北京协和医学院北京协和医院等11家医院收治的105例有生育要求的MOGCT患者的临床病理资料并进行回顾性分析.105例患者均行保留生育功能手术,根据其手术方式的不同分为3组,分期手术组:47例(44.8％),行全面分期手术,手术范围包括患侧附件切除+大网膜切除+腹膜后淋巴结切除±阑尾切除+腹膜多点活检；附件切除组:45例(42.9％),行患侧附件切除±对侧卵巢活检±大网膜切除术；肿物切除组:13例(12.4％),行肿物切除术.比较3组患者在手术相关指标、并发症、生育情况、预后等方面的差异.结果 (1)手术相关指标:分期手术组、附件切除组、肿物切除组患者的平均术中出血量分别为496、104、253 ml,3组比较,差异有统计学意义(P =0.011)；平均手术时间分别为176、114、122 min,3组比较,差异有统计学意义(P=0.000).(2)并发症:分期手术组、附件切除组、肿物切除组患者的手术并发症发生率分别为17％(8/47)、0、1/13,3组比较,差异有统计学意义(P=0.015).(3)生育情况:分期手术组、附件切除组、肿物切除组患者的妊娠率分别为9/19、7/19、2/3,3组比较,差异无统计学意义(P＝0.515);生育率分别为8/19、5/19、2/3,3组比较,差异无统计学意义(P =0.636).(4)预后:分期手术组、附件切除组、肿物切除组患者的复发率分别为13％(6/47) 、0、2/13,3组比较,差异有统计学意义(p=0.013)；病死率分别为6％(3/47)、0、0,3组比较,差异无统计学意义(P=0.129)；5年累积生存率分别为89％ 、100％ 、100％,3组比较,差异无统计学意义(P＞0.05)；5年累积无瘤生存率分别为85％ 、100％ 、83％,3组比较,差异有统计学意义(P＜0.05).结论 与分期手术相比,附件切除术的并发症少、疗效显著、预后较好,且获得较为满意的妊娠率、生育率；而肿物切除术虽并发症较少,但预后较差.%Objective To investigate the operative treatment for first-treated patients with malignant ovarian germ cell tumors who need preservation of fertility.Methods The clinical data of 105 patients who were treated with fertility-sparing surgery in 11 hospitals from 1992 to 2010 were collected to evaluate the outcomes of different primary surgical operative procedures.All 105 cases were performed the surgeries that preserved fertility and divided into three groups according to the surgical approaches,comprehensive staging surgery group:47 cases (44.8％) received comprehensive staging surgeries that including the ipsilateral oophorectomy + omentectomy + retropertoneal lymph node dissection ± appendectomy + multiple biopsies;oophorcctomy group:45 cases (42.9％) received ipsilateral oophorectomy ± biopsy of contralateral ovary ±omentectomy;tumor resection group:13 cases(12.4％)received enucleation of the mass with preservation of the ovary.Differences were compared among the three groups of patients in the surgery-related indicators,complications,fertility and prognosis.Results (1) Surgery-related indicators:the average blood loss of the comprehensive staging surgery group,the oophorectomy group and the tumor resection group were 496,104 and 253 ml,the mean operation time were 176,114 and 122 minutes,respectively,and there were significant differences among three groups (P =0.011,P =0.000).(2) Complication:the surgical complication rates of the three groups were 17％ (8/47),0 and 1/13,with significant differences (P =0.015).(3) Reproductive function status:the pregnancy rate and birth rate of the three groups were no significant differences(9/19 vs.7/19 vs.2/3,P =0.515 ;8/19 vs.5/19 vs.2/3,P =0.636).(4) Prognosis:the recurrence rate of the three groups were significant differences[13％ (6/47) vs.0 vs.2/13,P =0.013],but the death rate with no significant differences[6％ (3/47) vs.0 vs.0,P =0.129] ;The five-year survival rate of three different groups were 89％,100％ and 100％ (P ＞ 0.05),while disease free survival rate were 85％,100％ and 83％ (P ＜ 0.05),respectively.Conclusions Compared with comprehensive staging surgery,oophorectomy group have higher surgical security and satisfactory prognosis,considerable pregnancy rates and birth rate.The tumor resection security may be reliable,but the prognosis is poor.
展开▼
