Schwartz P E
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Forum (Genova). 2000 Oct-Dec;10(4):355-65.
The surgical management of germ cell tumours of the ovary is based on the premise of preserving fertility. Ovarian germ cell tumours occur in young women in whom fertility preservation is of great concern. Overwhelmingly ovarian germ cell tumours are benign, the most common form of which is the benign cystic teratoma (dermoid cyst). Cystectomies with preservation of the ovarian remnant should be the routine surgical treatment of benign cystic teratomas. Management of ovarian germ cell malignancies also focuses on preservation of fertility. These tumours, with the exception of dysgerminoma are overwhelmingly unilateral. All are exquisitely sensitive to cytotoxic chemotherapy and fertility has been preserved and successful conception has occurred even in women with advanced stage disease following surgery and chemotherapy. Cytoreductive surgery plays a role in the treatment of non-dysgerminomatous ovarian germ cell malignancies, but is not necessary for the management of ovarian dysgerminomas as the latter are exquisitely sensitive to chemotherapy. Second-look surgery is no longer routinely recommended in the management of these disorders due to the low incidence of positivity when patients have been treated with modern combination chemotherapy. The role of surgery in the management of recurrent disease has yet to be established due to the low incidence of persistent disease following modern combination chemotherapy.
卵巢生殖细胞肿瘤的外科治疗基于保留生育能力的前提。卵巢生殖细胞肿瘤发生于年轻女性，她们极为关注生育能力的保留。绝大多数卵巢生殖细胞肿瘤是良性的，最常见的形式是良性囊性畸胎瘤（皮样囊肿）。保留卵巢残余组织的囊肿切除术应是良性囊性畸胎瘤的常规外科治疗方法。卵巢生殖细胞恶性肿瘤的治疗也侧重于保留生育能力。除无性细胞瘤外，这些肿瘤绝大多数是单侧的。所有这些肿瘤对细胞毒性化疗都极为敏感，即使是患有晚期疾病的女性，在手术和化疗后生育能力也得以保留且成功受孕。肿瘤细胞减灭术在非无性细胞瘤性卵巢生殖细胞恶性肿瘤的治疗中发挥作用，但对于卵巢无性细胞瘤的治疗并非必需，因为后者对化疗极为敏感。由于采用现代联合化疗治疗的患者阳性率较低，因此在这些疾病的管理中不再常规推荐二次探查手术。由于现代联合化疗后持续性疾病的发生率较低，手术在复发性疾病管理中的作用尚未确立。
