Hollins G W, Thomas S, Lanigan D J, Dahar N, Jodrell D, Kaye S B, Kirk D
Department of Urology, Western Infirmary, Glasgow, UK.
Br J Urol. 1996 Apr;77(4):571-6. doi: 10.1046/j.1464-410x.1996.93116.x.
To review the results of the use of laparotomy to excise retroperitoneal metastases in patients with malignant teratoma of the testis.
The results of surgery for retroperitoneal teratoma metastases in 37 patients during the 5-year period from 1988 to 1993 were reviewed. Information on sexual dysfunction was obtained using a postal questionnaire.
Patients were divided into three groups: the first comprised 28 patients who underwent elective surgery (excision of residual disease) after platinum and bleomycin-based chemotherapy. The second group comprised four patients who underwent interventional surgery to excise disease not responding to treatment, after which they completed chemotherapy. The third group comprised five patients who underwent surgery for relapsed disease; two had suffered an early and three a late relapse. Overall, 34 patients are alive, four are considered to have residual disease and two have recently undergone re-operation.
In addition to removing residual disease after primary chemotherapy, surgery has a wider role in the management of metastatic teratoma. Carefully timed interventional surgery for disease not responding to chemotherapy can be lifesaving. Surgery for early relapse should be preceded by chemotherapy but surgery alone is appropriate where relapse occurs several years after primary treatment, although raised levels of tumour markers or extensive recurrence might be an indication for preliminary chemotherapy.
回顾采用剖腹手术切除睾丸恶性畸胎瘤患者腹膜后转移灶的结果。
回顾了1988年至1993年这5年间37例腹膜后畸胎瘤转移患者的手术结果。通过邮寄问卷获取性功能障碍方面的信息。
患者分为三组：第一组包括28例在接受以顺铂和博来霉素为基础的化疗后接受择期手术（切除残留病灶）的患者。第二组包括4例接受介入手术切除对治疗无反应病灶的患者，术后完成化疗。第三组包括5例因疾病复发接受手术的患者；2例为早期复发，3例为晚期复发。总体而言，34例患者存活，4例被认为有残留病灶，2例最近接受了再次手术。
除了在初次化疗后切除残留病灶外，手术在转移性畸胎瘤的治疗中具有更广泛的作用。对化疗无反应的疾病进行适时的介入手术可挽救生命。早期复发患者手术前应先进行化疗，但如果在初次治疗数年之后复发，单独手术是合适的，不过肿瘤标志物水平升高或广泛复发可能提示需要进行初步化疗。
