二例卵巢内胚窦瘤病例报告及有关生殖功能保护的文献复习  

The two cases report of endodermal sinus tumor and literature review related to the protection of reproductive function

作　　者：沈兰[1] 李爱斌[1] 曹景云[1] 陈力[1] 牛婷[1] 

机构地区：[1]武汉大学人民医院生殖中心,武汉436060

出　　处：《中国优生与遗传杂志》2014年第9期159-162,共4页Chinese Journal of Birth Health & Heredity

摘　　要：目的通过对2例卵巢内胚窦瘤病例报告及文献复习讨论,探讨对此类患者治疗与生育与生殖功能保护的方法。方法报告在武汉大学人民医院治疗的2例卵巢内胚窦瘤病例,复习其病史、检查、诊断及治疗,查阅相关文献后对该病的病理、临床表现、诊断及治疗予以讨论,寻求此类患者生育及生殖功能保护的方法。结果 1名17岁患者因患"右侧卵巢内胚窦瘤Ⅰa期术后"未生育,行保留生育能力手术,术后给予GnRHa行卵巢抑制和行BEP方案化疗;1名40岁患者因"左侧卵巢恶性肿瘤Ic期"无生育要求,行全面分期手术并先后行7次BEP方案化疗,复发后行剖腹探查术+盆腔粘连松解术+盆腔肿瘤切除术,术后行VAC方化疗。结论对于卵巢恶性生殖细胞肿瘤病人的治疗,化疗首选铂类药物;GnRHa用于抑制卵巢从而保留生育功能;可以采用卵母细胞的冷冻、卵巢皮质组织保存、体外成熟培养保存、胚胎冷冻、卵巢移位手术保护卵巢功能;有资料表明可以采用卵母细胞凋亡抑制剂1-磷酸-神经鞘氨醇(SIP)保留化疗后卵母细胞的功能,采用细胞保护剂(氨磷丁)清除化疗药物代谢产生的氧自由基,减少氧自由基对生殖细胞的损害;胚胎干细胞移植和肿瘤靶向药物的开发及应用也运用于保护卵巢功能。Objective： To discuss two cases report of endodermal sinus tumor and literature review, to explore the diagnosis and treatment of such patients with fertility and reproductive function protection method. Methods： Report the treatment of two cases of endodermal sinus tumor and review of its history, examination, diagnosis and treatment, after consulting relevant literature on the pathology, clinical manifestation, diagnosis of the disease and treatment to be discussed, seeking fertility and reproductive function of patients with this kind of protection method. Results： A 17-year-old patient because of “the right side of the ovaries embryo sinus tumor a period after” childless, preserve fertility surgery, postoperative lines given GnRHa ovarian suppression and BEP scheme chemotherapy; A 40-year-old for Ic“period” left ovarian malignancy in patients with no fertility requirements, line comprehensive staging surgery and has seven BEP scheme chemotherapy, laparotomy was recurrence after ＋ pelvic adhesion solution ＋ pelvic tumor resection operation, postoperative chemotherapy VAC party. Conclusion： In the treatment of malignant ovarian germ cell tumor patients, preferred platinum chemotherapy drugs; GnRHa used to inhibit ovarian in order to retain reproductive function; Can use frozen embryos, ovarian cortical tissue preservation and transplantation, ovarian cortex tissue in vitro culture of preservation, oocyte freezing, ovarian shift operation to protect the ovarian function; Data indicated that can take the oocyte apoptosis inhibitor 1 - phosphate - nerve sheath ammonia alcohol （SIP） to retain the function of oocytes after chemotherapy, the cell protective agent （ammonia phosphorus butyl） chemotherapy drug metabolism of oxygen free radical, reduce oxygen free radical damage to the reproductive cells; Embryonic stem cells transplantation and tumor development and annlication of targeted drugs are annlied to Drotect the ovarian function.

关 键 词：卵巢内胚窦瘤 生育与生殖功能保护 保留生育功能手术 化疗 GnRHa 辅助生育技术 卵巢移位 卵母细 胞凋亡抑制剂 细胞保护剂 

分 类 号：R737.31[医药卫生—肿瘤]