新辅助化疗在卵巢内胚窦瘤保留生育功能中的价值

目的 探讨年轻女性卵巢内胚窦瘤患者施行新辅助化疗的指征、方法及其在保留患者生育功能中的价值。方法 回顾性分析我院1996年至2010年收治的7例新辅助化疗后行保留生育功能手术的卵巢内胚窦瘤患者的临床及随访资料。结果 7例患者中，ⅢA2期2例，ⅢC期5例。1例患者因一般情况差、平卧位呼吸困难且合并有高钾、低钙、低蛋白考虑难以耐受手术选择行新辅助化疗，另6例患者分别因合并大量胸水（2例）、影像学提示盆腹腔广泛转移（2例）、有大量腹水且盆腔包块固定粘连（2例），而选择行新辅助化疗。新辅助化疗1～2个周期后均顺利完成保留生育功能手术，所有患者残留病灶均＜1 cm。术后继续给予BEP／BVP方案化疗，7例患者中1例失访，1例术后2年复发，行二次手术后1年再次复发死亡。其余5例随访63～132个月，无复发或死亡，其中完成生育者3例，未婚或无生育计划者2例。7例患者的5年生存率为71.4％（5／7）。结论 新辅助化疗可改善卵巢内胚窦瘤患者的一般情况、控制胸腹水、缩小盆腹腔病灶及降低术后残留病灶的发生率，有助于保留患者生育功能。

Role of neoadjuvant chemotherapy in the maintenance of fertility on young patients with ovarian yolk sac tumor

Objective To explore the indications， methods and role of neoadjuvant chemotherapy in the treatment of the young patients with ovarian yolk sac tumor who had the desire of maintaining fertility. Methods The retrospective analysis was based on 7 cases with ovarian yolk sac tumor treated with neoadjuvant chemotherary followed by interval preservative operation from 1996 to 2010. Results Two cases were in stage ⅢA2 and another five cases were in stage ⅢC. The reasons of neoadjuvant chemotherary for these cases were poor general condition and serious electrolyte disorder for one case， massive hydrothorax for two cases， extensive metastasis on the surface of intra-abdominal and pelvic organ for two cases， fixed pelvic tumors and massive ascites for another two cases. All these cases after neoadjuvant chemotherary underwent fertility saving surgery followed by adjuvant chemotherapy and their residual disease were small than 1 cm. Five among 7 patients have been alive up to now and one case was lost to follow up. Another case received second operation because of recurrence on two years after the first surgery， but she was died because of recurrence again one year later. Three cases among those five cases had successful deliveries. The 5-year survival rate of 7 patients was 71.4%(5/7). Conclusion Neoadjuvant chemotherary is a better treatment option for some patients with ovarian yolk sac tumor who hope to maintain fertility function， because the tumor status and general condition of the patients can be improved significantly after neoadjuvant chemotherary.