成人原发性腹膜后及骶尾部畸胎瘤诊治18例并文献复习

王潇 李丹霞 张铭鑫 田东旭 邹玉玮 牛海涛

[摘要] 目的 探討成人原发性腹膜后畸胎瘤、骶尾部畸胎瘤的临床特点和诊治经验。方法 收集2010—2018年于我院行手术治疗的成人原发性腹膜后畸胎瘤和骶尾部畸胎瘤的病历资料，进行回顾性分析。结果 18例畸胎瘤病人，男性3例，女性15例;术前腹痛者8例，无症状者8例，腰痛1例，尿频、尿急1例。5例病人行腹部B超检查，1例确诊;3例病人行CT平扫，2例确诊;15例病人行增强CT检查，12例确诊。5例病人行腹腔镜手术（2例中转开放手术），13例行传统开放手术。17例术后病理结果为成熟型囊性畸胎瘤，1例为恶性畸胎瘤。术后随访1例病人1年后原位复发，病理检查为成熟型囊性畸胎瘤，余病人均无复发。结论 成人原发性腹膜后及骶尾部畸胎瘤临床早期症状不明显，多于健康查体时发现，增强CT对该病的术前诊断价值优于超声检查，根据畸胎瘤的位置及其与周围组织的关系可行腔镜手术完整切除畸胎瘤。良性畸胎瘤术后有复发风险，需定期复查。

[关键词] 畸胎瘤;腹膜后肿瘤;骶尾部;诊断;外科手术

[中图分类号] R730.269;R737  [文献标志码] B  [文章编号] 2096-5532（2020）06-0742-03

doi：10.11712/jms.2096-5532.2020.56.161 [开放科学（资源服务）标识码（OSID）]

[网络出版] 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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（本文编辑 马伟平）