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目的总结儿童畸胎瘤的手术措施,分析手术并发症的常见原因,以提高肿瘤切除率,减少手术并发症。方法对2002年2月-2011年5月本院收治的12例儿童骶尾部畸胎瘤的临床资料进行回顾性分析。男4例,女8例;年龄7个月～11岁,平均6.67岁。按Altman分类:Ⅰ型(显露型)5例,Ⅱ型(内外混合型)5例,Ⅲ型(哑铃状型)1例,Ⅳ型(隐匿型)1例。术前空腹血清AFP正常7例(<20μg.L-1),5例有不同程度的增高,其中2例>1 210μg.L-1。所有患儿均行手术切除肿瘤及尾骨,Ⅰ、Ⅱ、Ⅲ型患儿中9例采用经骶尾部倒“V”形切口切除术,2例因瘤体较大采取横梭形切口切除术,1例Ⅳ型患儿采用经腹骶联合切口切除术。恶性肿瘤患儿术后行联合化疗。结果本组瘤体完整切除10例,术中瘤体包膜破溃切除2例。病理检查证实良性7例,恶性5例。12例患儿术后全部进行随访,随访时间6个月～5 a。近期并发症有切口感染3例,直肠损伤1例;远期并发症小便失禁1例。术后复发2例,死亡1例。结论骶尾部畸胎瘤须尽早手术治疗。术中切除尾骨、避免肿瘤破溃残留是预防复发的关键。盆底修复,肛尾韧带重建及消灭死腔是减少术后并发症的关键。
Objective To summarize the surgical measures of teratoma in children and analyze the common causes of surgical complications to improve the tumor resection rate and reduce the complications of surgery. Methods The clinical data of 12 cases of sacrococcygeal teratoma admitted to our hospital from February 2002 to May 2011 were analyzed retrospectively. 4 males and 8 females; aged 7 months to 11 years, an average of 6.67 years. According to the classification of Altman, there were 5 cases of type Ⅰ (exposed type), 5 of type Ⅱ (internal and external mixed type), 1 type of type Ⅲ (dumbbell-shaped type) and 1 type of type Ⅳ (occult type). Preoperative fasting serum AFP normal 7 cases (<20μg.L-1), 5 cases were increased to varying degrees, of which 2 cases> 1 210μg.L-1. All children undergone surgical resection of the tumor and coccyx, 9 cases of type Ⅰ, Ⅱ, Ⅲ children by sacrococcygeal inverted “V” shaped incision, 2 cases of large tumor taken transverse spindle incision Surgery, 1 case of type IV children with abdominal sacral incision resection. Malignant tumor patients underwent combined chemotherapy. Results The complete resection of the tumor in this group of 10 cases, intraoperative tumor capsule rupture in 2 cases. Pathological examination confirmed benign in 7 cases, malignant in 5 cases. All 12 cases were followed up for 6 months to 5 years. Recent complications were incision infection in 3 cases, 1 case of rectal injury; long-term complications of urinary incontinence in 1 case. Postoperative recurrence in 2 cases, 1 died. Conclusion Sacrococcygeal teratoma should be treated as soon as possible. Surgery to remove the coccyx, to avoid rupture of the tumor is the key to preventing recurrence. Pelvic floor repair, reconstruction of the anal tail ligament and the elimination of dead space is the key to reducing postoperative complications.