儿童及青少年卵巢肿瘤较成人少见,占所有儿童恶性肿瘤的1%。临床表现常常不典型,腹痛是最常见的临床症状。彩超常作为首选的影像学检查,可以通过彩超初步帮助鉴别卵巢肿瘤的良恶性。CT、MRI、肿瘤标志物等检查也是术前常用的辅助检查。儿童及青少年卵巢良性肿瘤中最多见为成熟畸胎瘤,良性肿瘤的手术方式首选卵巢肿瘤剔除术,但应尽可能保留卵巢组织。儿童及青春期卵巢恶性肿瘤多是早期,倾向于低期别、低级别,主要为恶性生殖细胞肿瘤(MOGCT)。保留生育功能的手术(保留子宫和至少部分卵巢组织)现在被认为是年轻MOGCT患者的标准手术治疗方法,而且目前多数学者认为,只要对侧卵巢及子宫未受累,无论MOGCT期别的早晚均可行保守性手术。另外手术切除联合以铂为基础的化疗在儿童MOGCT中都取得了良好的结果,其中PEB (顺铂、依托泊苷和博莱霉素)是最常用的化疗方案,但也要考虑如何保护卵巢,减少化疗对卵巢的影响。
Ovarian tumors in children and adolescents are less common than in adults, accounting for 1% of all pediatric malignant tumors. The clinical presentation is often atypical, with abdominal pain being the most common clinical symptom. Color Doppler ultrasound is often the first choice of imaging examination, which can initially help distinguish benign and malignant ovarian tumors. CT, MRI and tumor markers are also commonly used as auxiliary tests before surgery. The most common benign ovarian tumors in children and adolescents are mature teratomas. Ovarian tumor removal is the first choice for benign ovarian tumors, but ovarian tissue should be preserved as much as possible. Most ovarian malignant tumors in children and adolescence are early stage, tend to be low-stage and low-grade, and are mainly malignant germ cell tumors (MOGCT). Fertility preserving surgery (preserving the uterus and at least part of the ovarian tissue) is now considered the standard sur-gical treatment for young patients with MOGCT, and most scholars believe that conservative surgery is feasible in the early and late stages of MOGCT as long as the contralateral ovary and uterus are not involved. In addition, both surgical resection and platinum-based chemotherapy have achieved good results in pediatric MOGCT. PEB (cisplatin, etoposide, and bleomycin) is the most commonly used chemotherapy regimen, but it is also necessary to consider how to protect the ovary and re-duce the impact of chemotherapy on the ovary.
儿童,青少年,卵巢恶性肿瘤,保留生育功能,手术,化疗, Children Adolescents Malignant Tumor of Ovary Preservation of Fertility Function Surgery Chemotherapy摘要
Clinical Features and Advances in Diagnosis and Treatment of Ovarian Tumors in Children and Adolescents
Yalan Zan
Children’s Hospital Affiliated to Chongqing Medical University, Chongqing
Received: Jul. 24th, 2022; accepted: Aug. 22nd, 2022; published: Aug. 29th, 2022
ABSTRACT
Ovarian tumors in children and adolescents are less common than in adults, accounting for 1% of all pediatric malignant tumors. The clinical presentation is often atypical, with abdominal pain being the most common clinical symptom. Color Doppler ultrasound is often the first choice of imaging examination, which can initially help distinguish benign and malignant ovarian tumors. CT, MRI and tumor markers are also commonly used as auxiliary tests before surgery. The most common benign ovarian tumors in children and adolescents are mature teratomas. Ovarian tumor removal is the first choice for benign ovarian tumors, but ovarian tissue should be preserved as much as possible. Most ovarian malignant tumors in children and adolescence are early stage, tend to be low-stage and low-grade, and are mainly malignant germ cell tumors (MOGCT). Fertility preserving surgery (preserving the uterus and at least part of the ovarian tissue) is now considered the standard surgical treatment for young patients with MOGCT, and most scholars believe that conservative surgery is feasible in the early and late stages of MOGCT as long as the contralateral ovary and uterus are not involved. In addition, both surgical resection and platinum-based chemotherapy have achieved good results in pediatric MOGCT. PEB (cisplatin, etoposide, and bleomycin) is the most commonly used chemotherapy regimen, but it is also necessary to consider how to protect the ovary and reduce the impact of chemotherapy on the ovary.
Keywords:Children, Adolescents, Malignant Tumor of Ovary, Preservation of Fertility Function, Surgery, Chemotherapy
昝亚兰. 儿童及青少年卵巢肿瘤临床特点及诊治进展Clinical Features and Advances in Diagnosis and Treatment of Ovarian Tumors in Children and Adolescents[J]. 临床医学进展, 2022, 12(08): 8020-8026. https://doi.org/10.12677/ACM.2022.1281155
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