儿童骶尾部畸胎瘤预后相关因素分析  

Correlation prognostic analysis of sacrococcygeal teratoma in children

作　　者：高婷婷 徐伟珏 吕志宝 陈发玲 Gao Tingting;Xu Weijue;Lyu Zhibao;Chen Faling(Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200000,China)

机构地区：[1]上海市儿童医院上海交通大学医学院附属儿童医院,上海200000

出　　处：《临床小儿外科杂志》2023年第1期62-66,共5页Journal of Clinical Pediatric Surgery

基　　金：上海市儿童医院青年培育项目(2018YQN005)

摘　　要：目的探讨影响儿童骶尾部畸胎瘤(sacrococcygeal teratoma,SCT)预后的相关因素。方法回顾性分析上海市儿童医院2011年3月至2019年4月收治的SCT患儿临床资料,通过随访患儿术后有无肿瘤复发、排便及排尿功能来评估其预后。将随访过程中出现肿瘤复发、排便及排尿功能异常中一种及以上并发症者归入预后不良组,无上述情况者归入预后良好组。从手术年龄、肿瘤大小、Altman分型、手术路径、术中肿瘤是否完整切除、肿瘤是否破溃以及肿瘤病理类型等方面分析影响SCT患儿预后的相关因素。结果共收治65例SCT患儿,其中获得完整随访61例。61例患儿中,术后出现肿瘤复发7例,根据Altman分型,Ⅰ型2例,Ⅱ型3例,Ⅲ型1例,Ⅳ型1例;未成熟性畸胎瘤3例,恶性畸胎瘤4例。术后出现便秘7例,根据Altman分型,Ⅰ型1例,Ⅱ型2例,Ⅲ型3例,Ⅳ型1例;成熟性畸胎瘤2例,未成熟性畸胎瘤4例,恶性畸胎瘤1例。术后出现反复尿路感染3例,根据Altman分型,Ⅱ型1例,Ⅲ型2例;成熟性畸胎瘤、未成熟性畸胎瘤及恶性畸胎瘤各1例。预后良好组48例,预后不良组13例。单因素分析发现,Altman分型、手术路径、病理类型、术中肿瘤是否破溃是SCT患儿预后不良的相关因素(P<0.05);多因素Logistic回归分析发现,病理类型(OR=17.322,95%CI:2.723~110.182)及Altman分型(OR=6.133,95%CI:1.281~29.374)是SCT患儿预后不良的独立相关因素(P<0.05)。结论SCT术后排便、排尿功能及肿瘤是否复发可影响患儿预后。SCT恶性程度、Altman分型及术中肿瘤破溃是影响SCT患儿预后的相关因素。手术中应注意保持肿瘤完整性(防止肿瘤破溃),减少对盆底肌肉、神经的损伤,以改善患儿预后。Objective To explore the relevant prognostic factors for children with sacrococcygeal teratoma(SCT).Methods A retrospective analysis of 65 hospitalized SCT children was performed between March 2011 and April 2019.Presence or absence of tumor recurrence and postoperative defecation and urination functions were recorded.Those with tumor recurrence,defecation or urination dysfunction belonged to group of poor prognosis.And the remainders were classified as group of good prognosis.Risk factors included operative age,tumor size,Altman type,surgical route and spillage of tumor.Results Among them,7 cases had tumor recurrence,including typeⅠ(n=2),typeⅡ(n=3),typeⅢ(n=1)and typeⅣ(n=1).There were mature teratoma(n=2),immature teratoma(n=4)and malignant teratoma(n=1).And 7 cases developed constipation,including typeⅠ(n=1),typeⅡ(n=2),typeⅢ(n=3)and typeⅣ(n=1).There were mature teratoma(n=2),immature teratoma(n=4)and malignant teratoma(n=1).Three children had recurrent urinary tract infections,including typeⅠ(n=1),typeⅡ(n=2),typeⅢ(n=3)and typeⅣ(n=1).There were mature teratoma(n=2),immature teratoma(n=4)and malignant teratoma(n=1).Among 61 SCT children,prognosis was good(n=48)and poor(n=13).Univariate analysis indicated that Altman type,surgical roué,spillage of tumor and pathology were poor risk factors.And multi-factorial Logistic regression analysis revealed that pathological type(OR=17.322,95%CI:2.723-110.182)and Altman type(OR=6.133,95%CI:1.281-29.374)were independent risk factors of poor prognosis(P﹤0.05).Conclusion In SCT children,prognosis is correlated with defecation and urination function and tumor recurrence.Altman type,spillage of tumor and pathology are the relevant prognostic factors.Thus maintaining the integrity of tumor and minimizing the injuries of pelvic floor muscles and nerve may improve the prognosis of SCT in children.

关 键 词：骶尾部 畸胎瘤 预后 影响因素分析 外科手术 儿童 

分 类 号：R739.95[医药卫生—肿瘤]