小儿骶尾部畸胎瘤的手术治疗

目的：回顾性总结小儿骶尾部畸胎瘤的手术治疗经验。方法：１６例小儿骶尾部畸胎瘤患者，男性５例，女性１１例，按Ａｌｔｍａｎ分类法，Ⅰ型１０例，Ⅱ型２例，Ⅲ型１例，Ⅳ型３例。临床表现主要有骶尾部包块、排便困难、呕吐、腹胀等，直肠指诊８例可触及包块。血清甲胎蛋白检测有３例升高。所有病例行手术切除肿瘤及尾骨，１２例经骶尾部手术，４例经腹和骶尾部联合手术，恶性者术后行化疗。结果：１６例患儿均获得随访，平均５８个月（７～１２０个月），１２例良性畸胎瘤中４例因复发再次手术治疗，其中２例恶变，死于肺转移。４例恶性患儿中１例局部复发再次手术切除，３例死于肝转移。并发症包括４例术后出现缝合伤口感染，１例皮下积液，２例出现暂时性排便困难。结论：小儿骶尾部畸胎瘤需要早期诊断，治疗手段主要是经骶尾部或经腹部和骶尾部联合手术完整切除肿瘤及尾骨，恶性者应配合放化疗。

Experiences on the surgical treatment of sacrococcygeal teratoma in children

Objective：To summarize retrospectively the experiences on surgical treatment of sacrococcygeal teratoma in chil- dren. Methods：There were 16 children with sacrococcygeal teratomas, 5 males and 11 females. According to Altman classification sys- tem, the 16 saerococcygeal teratomas were classified into 10 type-Ⅰ , 2 type-Ⅱ , 1 type-Ⅲ, 3 type-VI. The clinical features were local mass,difficult defecation,vomiting and abdominal distension. Through digital rectal examination the masses could be touched in 8 ca- ses. In 3 cases the AFP was higher than normal. All cases were performed tumor and coccyx resection through sacral or abdominosaeral approach and malignancies were managed by chemotherapy. Results：Sixteen patients were followed up mean 58 months（ range 7-120 months）. In 12 benign teratomas 4 relapsed aud were resected again in which 2 lransformed malignancy and died of lung metastasis. Three of 4 malignant teratomas died of liver metastases and l recurred and excised again. The eomplications included incision infection in 4, subcutaneous hydrops in 1 and temporal7 difficuh defecation in 2. Conclusion：The sacrocnccygeal teratoma must be diagnosed early and treated with tumor and coccyx resection through sacral or ahdominosacral approach. The malignancy should be managed with chemotherapy.