摘要
卵巢卵黄囊瘤(OYST)又称卵巢内胚窦瘤(OEST),属卵巢生殖细胞恶性肿瘤(MOGCT),发生率低,多见于儿童及青年女性,恶性程度高,生长迅速,易早期转移,预后差。甲胎蛋白(AFP)及磷脂酰肌醇3(glypican-3)是OYST重要的免疫组织化学标志物,铂类为基础的化疗药物显著提高了患者预后生存。因OYST对化疗药物敏感,保留生育功能是其手术原则,即使是对于分期较高的患者也可保留生育功能。手术+术后3~4周期辅助化疗(博来霉素、依托泊苷、铂类)系OYST的标准治疗方法。妊娠期合并OYST者少见,术后可以继续妊娠,孕期需要辅助化疗,但会增加胎儿畸形概率及孕妇死亡风险。肿瘤的组织类型、化疗方案种类的选择、肿瘤的分期、非满意的肿瘤细胞减灭术、术前血清AFP值及术后AFP下降值可对预后有影响,但手术方式的选择对患者预后影响不大。微创技术、辅助生殖技术及化疗期间卵巢功能的保护可使MOGCT患者获得益处。
Ovarian yolk sac tumour（OYST）, also called ovarian endodermal sinus tumour（OEST） are rare and highly malignant tumours of utmost importance occurring in children and young adults. AFP and glypican-3 are characteristic immunohistochemical markers. Cisplatin-based chemotherapy has dramatically improved the prognosis of OYST. Fertility-sparing surgery seems a reasonable approach in initial treatment even for patients with advanced stage. Three courses of BEP（bleomycin, etoposide, cisplatin） is the current standard therapy and four courses is recommended in case of bulky residual disease after surgery. There is a rare situation of ovarian yolk sac tumour complicating pregnancy in which adjuvant chemotherapy must be given after laparotomy. It can increase the risk of fetal malformation and pregnant death during gestation period. It may have an influence on prognosis in the case that tumor tissue types, selection of chemotherapy regimens, staging,not satisfied with the residual, preoperative and postoperative level of serum AFP. On the other hand, the choice of operation method has little impact on the prognosis of patients. Minimal invasive technique, assisted reproductive technology and protection of ovarian function during chemotherapy can make benefit in patients with malignant ovarian germ cell tumours.
出处
《国际妇产科学杂志》
CAS
2017年第2期137-141,共5页
Journal of International Obstetrics and Gynecology
关键词
内胚层窦瘤
肿瘤
生殖细胞和胚胎性
卵巢切除术
抗肿瘤联合化疗方案
甲胎蛋白类
Endodermal sinus tumor
Neoplasms
germ cell and embryonal
Ovariectomy
Antineoplastic combined chemotherapy protocols
alpha-fetoproteins
