婴幼儿纵膈畸胎瘤13例临床分析  

Clinical analyses of mediastinal teratonms in 13 infants

作　　者：唐决 刘威 梁建华 汪凤华 曾嘉航 

机构地区：[1]广州市妇女儿童医疗中心小儿外科,510080

出　　处：《中华小儿外科杂志》2014年第10期765-768,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的评估婴幼儿纵膈畸胎瘤的临床诊断、临床表现及手术疗效。方法回顾性研究2010年9月至2013年6月广州市妇女儿童医疗中心收治的13例婴幼儿纵隔畸胎瘤患儿。男10例，女3例，年龄5个月～2岁6个月，平均12个月，咳嗽10例，气促7例，发热6例，胸痛1例。所有患儿术前均行胸部X线片及CT检查。肿瘤位于前、上纵隔7例，前纵膈3例，后纵膈3例。结果本组13例均行肿瘤切除术，术中完整切除肿瘤12例，肿瘤体积最小为6．0cm×6．0cm×4．0cm，最大为15．0cm×12．0cm×10．0cm。术后病理检查证实均为畸胎瘤，其中9例为成熟畸胎瘤，3例为未成熟畸胎瘤，1例内胚层窦瘤。成熟畸胎瘤及未成熟畸胎瘤仅予手术切除，内胚层窦瘤结合手术及化疗综合治疗。所有患儿均痊愈出院。术后平均随访18个月（6～40个月），所有患儿存活，无肿瘤复发。术后发生肺部感染3例，膈膨升2例。结论婴幼儿纵膈畸胎瘤临床症状不典型，早期诊断需结合临床表现及CT等辅助检查。手术治疗是婴幼儿纵膈畸胎瘤安全有效的治疗方案，恶性畸胎瘤的治疗需结合手术及辅助性化疗。Objective To evaluate the surgical approach, presentation, and outcomes for mediastinal teratoma in infancy. Methods A total of 13 infants with mediastinal teratoma were treated between September 2010 and June 2013. Their medical records were analyzed retrospectively. The median age at diagnosis was 12 months. The most common presenting complaints were cough （n = 10）, dyspnea （n = 7）, fever （n = 6） and chest pain （n = 1）. Chest radiography and computed tomography （CT） were performed. The primary sites included upper and anterior mediastinum （n = 7）, anterior rnediastinum （n = 3） and posterior mediastinum （n = 3）. Results Among them, complete excision was achieved in 12 cases. These masses ranged in size from 6 × 6 × 4 cm3 to 15 × 12× 10 cm3. Histological examination showed that there were 9 mature teratomas, 3 immature teratomas and 1 malignant teratoma （yolk sac tumor）. Mature teratomas and immature teratomas underwent surgical resection alone. The patients with yolk sac tumors received postoperative adjuvant therapy. All cases were successfully treated. During a median follow-up period of 18 （6-40） months, all patients survived disease-free and there was no recurrence. The complications included lung infection （n = 3 ） and diaphragmatic eventeration （n = 2）. Conclusions The early diagnosis of neonatal suprarenal mass depends on clinical manifestations and CT scan. While surgical excision is safe and effective treatment for mature teratomas and immature teratomas, chemotherapy is essential for malignant teratomas after surgical resection.

关 键 词：畸胎瘤 内胚层窦瘤 纵膈 

分 类 号：R734.5[医药卫生—肿瘤]