化疗联合手术治疗小儿阴道内胚窦瘤的疗效分析  

Treatment of vaginal endodermal sinus tumor with chemotherapy and surgery in infants

作　　者：滕腾 刘江斌[1] 吕志宝[1] Teng Teng;Liu Jiangbin;Lv Zhibao(Department of General Surgery,Affiliated Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海交通大学附属儿童医院普外科,上海市200062

出　　处：《临床小儿外科杂志》2020年第8期717-720,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的总结阴道内胚窦瘤患儿的临床资料,探讨阴道内胚窦瘤。化疗联合局部病灶切除术的疗效。方法回顾性分析2012年11月至2016年5月上海市交通大学附属儿童医院普外科收治的5例阴道内胚窦瘤患儿的临床资料,发病年龄3~14个月,平均(6.8±3.87)个月,根据COG分期均为Ⅲ期,经阴道行膀胱镜检查肿块活检明确病理类型,术前予BEP或VIP方案化疗,化疗后根据影像学检查及经阴道膀胱镜检查确认可手术切除,再行经阴道或经腹部局灶性肿瘤切除术,术后继续化疗。结果5例患儿初始症状均为阴道出血,术前化疗2~5个疗程,化疗后血清AFP水平明显下降[化疗前713.55~18647 ng/mL,平均为(6455.8±6325)ng/mL;化疗后术前4.09~36.4 ng/mL,平均为(17.74±10.6)ng/mL];肿瘤大小明显缩小[化疗前直径1.74~4.33 cm,平均为(3.2±1.09)cm,化疗后术前直径0.8~2.0 cm,平均(1.28±0.43)cm];术后病理检查结果提示2例切缘仍有肿瘤细胞残留,3例切缘未见肿瘤细胞;术后继续化疗2~4个疗程,5例患儿均获得随访,随访17~55个月,平均(29.8±14.85)个月,血清AFP水平正常,影像学检查未见肿瘤复发,均无瘤存活。结论化疗联合经阴道或经腹部局灶性肿瘤手术切除治疗小儿阴道内胚窦瘤可以达到良好的疗效,同时保留了患儿的生育功能。Objective To summarize the clinical data of vaginal endodermal sinus tumor in infants and explore the efficacies of transabdominal or transvaginal resection of local foci plus chemotherapy for vaginal endodermal sinus tumor.Methods From November 2012 to May 2016,clinical data were retrospectively analyzed for 5 infants with vaginal endodermal sinus tumor.The average onset age was(6.8±3.87)(3-14)months.All cases belonged to COG stageⅢ.Pathological types were confirmed by biopsy through vagina by cystoscopy and preoperative chemotherapy of BEP/VIP prescribed.Based upon the findings of imaging studies and vaginal cystoscopy,transabdominal or transvaginal resection of foci tumor was performed after chemotherapy.Results The initial symptoms were vaginal bleeding.The serum AFP levels significantly decreased after 2-5 courses of chemotherapy[pre-chemotherapy 6455.8(713.55-18647)ng/mL,pre-operation 17.74(4.09-36.4)ng/mL].The size of tumor significantly declined[pre-chemotherapy 3.2(1.74-4.33)cm,pre-operation 1.28(0.8-2.0)cm].Marginal tumor cells persisted(n=2).All received 2-4 courses of chemotherapy.The average follow-up period was(29.8±14.85)(17-55)months.The serum levels of AFP were normal and imaging examination revealed no recurrence.All cases survived tumor-free.Conclusion For vaginal endodermal sinus tumors,chemotherapy plus transvaginal or transabdominal focal surgery may obtain excellent outcomes and preserve fertility function in infants.

关 键 词：阴道肿瘤 抗肿瘤联合化疗方案 泌尿生殖外科手术 儿童 

分 类 号：R730.53[医药卫生—肿瘤] R730.56[医药卫生—临床医学]