成人原發性腹膜后及骶尾部畸胎瘤診治18例并文獻復習

王瀟 李丹霞 張銘鑫 田東旭 鄒玉瑋 牛海濤

[摘要] 目的 探討成人原發性腹膜后畸胎瘤、骶尾部畸胎瘤的臨床特點和診治經驗。方法 收集2010—2018年于我院行手術治療的成人原發性腹膜后畸胎瘤和骶尾部畸胎瘤的病歷資料，進行回顧性分析。結果 18例畸胎瘤病人，男性3例，女性15例;術前腹痛者8例，無癥狀者8例，腰痛1例，尿頻、尿急1例。5例病人行腹部B超檢查，1例確診;3例病人行CT平掃，2例確診;15例病人行增強CT檢查，12例確診。5例病人行腹腔鏡手術（2例中轉開放手術），13例行傳統開放手術。17例術后病理結果為成熟型囊性畸胎瘤，1例為惡性畸胎瘤。術后隨訪1例病人1年后原位復發，病理檢查為成熟型囊性畸胎瘤，余病人均無復發。結論 成人原發性腹膜后及骶尾部畸胎瘤臨床早期癥狀不明顯，多于健康查體時發現，增強CT對該病的術前診斷價值優于超聲檢查，根據畸胎瘤的位置及其與周圍組織的關系可行腔鏡手術完整切除畸胎瘤。良性畸胎瘤術后有復發風險，需定期復查。

[關鍵詞] 畸胎瘤;腹膜后腫瘤;骶尾部;診斷;外科手術

[中圖分類號] R730.269;R737 ?[文獻標志碼] B ?[文章編號] 2096-5532（2020）06-0742-03

doi：10.11712/jms.2096-5532.2020.56.161 [開放科學（資源服務）標識碼（OSID）]

[網絡出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20200720.1401.005.html;

[ABSTRACT] Objective To investigate the clinical features and experience in the diagnosis and treatment of adult patients with primary retroperitoneal teratoma and sacrococcygeal teratoma. Methods A retrospective analysis was performed for medical records of the adult patients with primary retroperitoneal teratoma and sacrococcygeal teratoma who underwent surgery in our hospital from 2010 to 2018. ?Results Among the 18 patients with teratoma， there were 3 male patients and 15 female patients; 8 patients had abdominal pain before surgery， 8 had no symptoms， 1 had low back pain， and 1 had frequent urination and urgency of urination. Abdominal ultrasound was performed for 5 patients， among whom 1 was confirmed; plain CT scan was performed for 3 patients， among whom 2 were confirmed; contrast-enhanced CT scan was performed for 15 patients， among whom 12 were confirmed. Of all 18 patients， 5 underwent laparoscopic surgery （among whom 2 were converted to open surgery） and 13 underwent traditional open surgery. The postoperative pathological results were mature cystic teratoma for 17 patients and malignant teratoma for 1 patient. During follow-up， 1 patient experienced recurrence in situ 1 year later， and pathological examination showed mature cystic teratoma. No recurrence was observed in the other 17 patients. Conclusion Adult patients with primary retroperitoneal and sacrococcygeal teratoma have no obvious clinical symptoms in the early stage and are often found by physical examination. Contrast-enhanced CT is better than ultrasound in the preoperative diagnosis of retroperitoneal and sacrococcygeal teratoma， and endoscopic surgery can be used to completely remove the teratoma based on the location of the teratoma and its relationship with the surrounding tissue.

[KEY WORDS] teratoma; retroperitoneal neoplasms; sacrococcygeal region; diagnosis; surgical procedures， operative

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（本文編輯 馬偉平）