卵巢未成熟畸胎瘤43例综合治疗疗效分析

为探讨不同手术方式及化疗方法对卵巢未成熟畸胎瘤的疗效及相关影响因素，对43例卵巢未成熟畸胎瘤患者进行回顾性分析。手术方式分为：保守性手术（患侧附件、大网膜切除术＋盆、腹腔腹膜结节切除术＋盆腔淋巴结清扫术）及根治性手术（全子宫、双附件及大网膜切除术＿肿瘤细胞减灭术＋盆腔淋巴结清扫术）。术后采用VAC（长春新碱，阿霉素，环磷酰胺）方案、BEP（博莱霉素或平阳霉素，足叶乙叉甙，顺铂或卡铂）方案或VBP（长春新碱，博莱霉素或平阳霉素，顺铂或卡铂）方案进行联合化疗。患者5年生存率根治性手术为44．4％，保守性手术为64．0％，差异无显著性。VAC方案与BEP（或VBP）方案的5年生存率分别为33．3％和77．3％（P＜0．01）。疗程数≥4患者的5年生存率为73．9％，明显高于疗程数＜4患者的38．9％（P＜0．05）。认为对于有生育要求的卵巢未成熟畸胎瘤患者，可仅行保守性手术，术后辅以联合化疗。BEP（或VBP）方案对患者长期生存率的改善明显优于VAC方案。术后化疗的疗程数与疗效有关，对长期生存率的影响较明显。

Combined Therapies for 43 Patients with Ovarian Immature Teratoma

The therapeutic effects of combined therapies for ovarian immature teratoma and relative factors were investigated. From Aug. 1979 to July. 1999, 43 patients with ovarian immature teratoma hospitalized in our department were eligible for retrospective study. Young patients having no child underwent the conservative surgery: remove the involved ovary and the oviduct, omentum, peritoneal metastases, and pelvic lymph nodes. And those who had no desire to have child received radical surgery: including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, resection of peritoneal metastases, and removal of pelvic lymph nodes. All the patients received systemic and(or) intra-abdominal chemotherapy after operation. Regimens were VAC (vincristine, adriamycin, cyclophosphomide), VBP (vincristine, bleomycin, cisplatin or carboplatin) and BEP (bleomycin, etoposide, cisplatin or carboplatin). The 5-year-survival rate of the patients receiving conservative surgery was 44.0 %, lower than that (64.0 %) in the patients receiving radical surgery, but the difference was not significant between them (P>0.05). The 5-year-survival rate of the patients treated by BEP (or VBP) was 77.3 %, significantly higher than that (33.3 %) by VAC (P<0.01). The 5-year survival rate of the patients receiving less or more than 4 courses of combined chemotherapy was 38.9 % and 73.9 % respectively (P<0.05). We considered that in young patients having no child, the uterus and contra lateral ovary might be preserved to maintain fertility. BEP (or VBP) are the more effective regimens for ovarian immature teratoma than VAC. The courses of combined chemotherapy also influence the prognosis of the patients with ovarian immature teratoma.