青春期女性生殖道恶性肿瘤39例临床分析

摘要：目的 探讨青春期少女生殖道恶性肿瘤的临床特点，治疗及预后。方法 回顾性分析天津市中心妇产科医院1997年1月至2008年10月收治的39例青春期生殖道恶性肿瘤患者的临床资料。结果 卵巢恶性肿瘤26例，占66.7%（26/39），其中生殖细胞肿瘤20例，上皮性肿瘤占4例，颗粒细胞瘤1例，恶性B细胞淋巴瘤1例；子宫恶性肿瘤6例，其中子宫内膜癌3例，子宫腺肉瘤及低度恶性子宫内膜间质肉瘤各1例，宫颈横纹肌肉瘤1例；妊娠滋养细胞肿瘤(GTN)6例；盆腔恶性纤维恶瘤1例。卵巢癌患者96.2%（25/26）行保留生育功能手术，1例行根治性手术，术后均接受化学治疗；子宫恶性肿瘤中4例宫体恶性肿瘤保留了卵巢功能，1例行根治性手术，1例宫颈横纹肌肉瘤因临床期别较晚未行手术治疗，6例患者均接受了化疗；5例GTN患者接受了5-氟尿嘧啶与更生霉素联合化疗，1例因失去治疗机会未予化疗；盆腔恶性纤维瘤患者行肿物切除术后予以化疗。平均随访59.7个月，5年生存率86.0%。早期上皮性卵巢癌行保留生育功能手术患者及Ⅰ期子宫内膜癌行保留卵巢功能手术术后随访均无复发。保留子宫患者化疗停止6个月后92.9%(26/28)恢复正常月经。结论 青春期少女生殖道恶性肿瘤发病率低，仅占同期收治妇科恶性肿瘤1.12%，多数为卵巢生殖细胞肿瘤。治疗尽可能采用保留生育功能手术辅以术后化疗，以提高患者生存质量。Ⅰ期分化好的上皮性卵巢癌可考虑行保留生育功能手术，早期子宫内膜癌可保留卵巢功能。化疗对青春期少女卵巢功能无显著影响。

The Female Genital Tract Malignant Tumor in Adolescent--39 cases report

Abstract Objective: To analyse the character of symptom, treatment, and prognosis of female genital tract cancer in adolescent. Method: Retrospect 39 cases of adolescent female genital tract cancer treated in the Tianjin Central Hospital of Obstetrics and Gynecology from Jan. 1997 to Oct. 2008. Outcome: There were 26 ovarian cancer, which included 20 cases of germ cell tumor, 4 cases of epithelial cancer, a case of juvenile granulosa cell tumor, and a case of malignant lymphoma . Among 6 cases of uterine malignant tumor, there were 3 cases of endometrial cancer, 1 case of adenosarcoma, low grade endometrial stromal sacoma, and cervical rhabdomyosarcoma, respectively. Furthermore, there were 6 cases of gestational trophoblastic tumour and 1 case of malignant pelvic fibroma. The common symptoms were increasing of abdominal circumference and abdominal pain in ovarian cancer and passing vagina bleeding in uterine cancer. In ovarian cancer, 96.2%(25/26) patients received conservative surgery and 1 patient received radical surgery. All of the patients received adjuvant chemotherapy. In uterine cancer, 4 cases received ovarian conservative surgery, 1 case received radical surgery, and surgery wasn’t done in the cervical rhadomyosarcoma for advanced stage. Chemotherapy was done in all of the uterine cancer cases. 5 cases of the 6 GTN received combination chemotherapy of 5-FU and ACT-D. The other case of GTN wasn’t treated with chemotherapy, because she missed the treatment opportunity. The malignant pelvic fibroma patient received the debulking surgery and adjuvant chemotherapy. Average duration of follow-up period was 59.7 months. 5-years survival rate was 86.0%. All of the patients with conversation operation in early stage epithelial ovarian cancer and with ovarian preservation surgery in stageⅠendometrial cancer were survival without tumor.92.9% of patients with conservative treatment got regular menses at the sixth month post chemotherapy. Conclusion: The morbidity of adolescent female genital tract cancer is low, just engages 1.12% in all age group. Most of them are ovarian germ cell tumor. Main treatment should be conservative surgery followed with chemotherapy, which is benefit to the patients’ quality of life. Conservative surgeries can be done in stageⅠepithelial ovarian cancer and ovarian preservation surgery can be done in stageⅠendometrial cancer. There isn’t obvious influence on ovarian function post chemotherapy.