颅内混合性生殖细胞肿瘤诊治效果分析  

Intracranial mixed germ cell tumor

作　　者：赵亚鹏[1] 张玉琪[2] 段虹宇[2] 马羽[2] 梁晖[2] 张庆辉[2] 薛超强[2] 罗斌[2] 潘鑫[2] 

机构地区：[1]清华大学医学中心,北京100084 [2]清华大学玉泉医院神经外科

出　　处：《中华医学杂志》2017年第9期661-665,共5页National Medical Journal of China

基　　金：国家自然科学基金（81470048）

摘　　要：目的探讨颅内混合性生殖细胞肿瘤的诊断及合理化治疗策略。方法对象为清华大学玉泉医院2012年10月至2016年10月收治的17例颅内混合性生殖细胞肿瘤患者，17例中男10例，女7例；平均年龄（11.1±5.2）岁；回顾性分析病例特点、血清中肿瘤标志物甲胎蛋白（AFP）、特异性人绒毛膜促性腺激素（β－HCG）、癌胚抗原（CEA）的结果、影像学检查结果、病理学结果以及治疗方法和预后状况。结果17例中9例全切除病变，8例近全切除病变；未复发患者8例（47.1%），其中有7例手术全切除病变，1例近全切除病变，术后均有至少4个疗程的化疗；复发患者9例（52.9%），其中有2例手术全切除病变，7例为近全切除病变，复发后的患者中有4例再次手术切除病变，有6例化疗后联合放疗取得了比较满意的治疗效果。在17例患者的病理类型中含有畸胎瘤（包括成熟、未成熟或恶性畸胎瘤）成分的肿瘤有12例，占70.6%。随访时间自手术后算起，平均（17.5±12.1）个月，4例（23.5%）患者死亡。结论颅内混合性生殖细胞肿瘤的诊断需要综合考虑患者血清或脑脊髓液中肿瘤标志物特点，放、化疗状况以及病理学结果；全切除病变有助于降低肿瘤复发的机会；合理的放、化疗有助于预后。Objective To study intracranial mixed germ cell tumor diagnosis and reasonable treatment strategy.Methods Clinical data of 17 patients with intracranial mixed germ cell tumor in Tsinghua university Yuquan hospital from October 2012 to October 2016 were retrospective analysed, including the characteristics of the general, the serum tumor markers of AFP, β-HCG, and CEA, imaging findings, pathological results, treatment methods and prognosis.Results There were 10 cases of male, 7 cases of female. The average age was （11.1±5.2） years old. Nine cases were gross total resection of lesions and 8 cases were subtotal resection of lesions. Eight cases （47.1%） were without recurrence and had more than four courses of chemotherapy after surgery, of which, 7 cases belonged to the gross total resection, and 1 case belonged to the subtotal resection. Nine （52.9%） patients relapsed, including 2 cases of the gross total resection and 7 cases of the subtotal resection. Among them, 4 cases were given second operations and 6 cases obtained satisfactory therapeutic effect by chemotherapy combined radiotherapy. There were 12 of 17 patients with pathological types contain teratoma （including mature, immature or malignant teratoma） ingredients, accounting for 70.6%. The average follow-up time was （17.5±12.1） months, 4 cases （23.5%） patients died.Conclusion The diagnosis of intracranial mixed germ cell tumors needs comprehensive consideration of tumor markers in serum or cerebrospinal fluid, chemotherapy and radiotherapy before operation and pathological results. The gross total resection helps to reduce the chances of tumor recurrence. Rational chemotherapy and radiotherapy is helpful to prognosis.

关 键 词：混合性生殖细胞肿瘤 肿瘤标志物 手术 化疗 放疗 

分 类 号：R739.41[医药卫生—肿瘤]