摘要目的 探讨颅内生殖细胞肿瘤(ICGCTs)的个体化治疗效果.方法 回顾性纳入清华大学玉泉医院神经外科2012年10月至2016年6月行手术治疗的ICGCTs患者,共32例.首次术后病理学检查6例为生殖细胞瘤;26例为非生殖细胞瘤性生殖细胞肿瘤(NGGCTs),其中混合性ICGCTs 14例,成熟畸胎瘤4例,未成熟畸胎瘤6例,恶性畸胎瘤1例,绒癌1例.术前4例行化疗;术后16例行化疗,3例行局部放疗,2例行化疗+局部放疗.结果 32例中,平均随访(21.8±13.5)个月;手术全切除17例(53.1％),未全切除15例(46.9％).12例复发,其中全切除组有3例(3/17),未全切除组9例(9/15),两组复发的比例差异有统计学意义(P =0.027);有2例复发前后病理学结果不一致.无严重手术相关并发症;6例(18.8％)死亡,其中5例术后未行放、化疗,肿瘤复发死亡.结论 显微手术是治疗ICGCTs的一个重要手段,尤其是对NGGCTs,患者可从全切除病变中获益.手术前后个体化的放、化疗对减少复发有益.

abstractsObjective To analyze the treatment effects of intracranial germ cell tumors (ICGCTs) using microsurgery.Methods A retrospective study was conducted on the data of 32 cases of ICGCT who were admitted to Yuquan Hospital of Tsinghua University from October 2012 to June 2016.Among them,there were 6 cases of germinoma,14 cases of mixed ICGCT,4 cases of mature teratoma,6 cases of immature teratoma,1 case of malignant teratoma and 1 case of choriocarcinoma.Preoperative chemotherapy was performed in 4 cases.Postoperatively,16 cases received chemotherapy,3 cases underwent local radiotherapy,and 2 cases underwent chemotherapy plus local radiotherapy.The surgical outcomes were followed up.Results For the 32 cases,the average follow-up period was (21.8 ±13.5) months.The gross total resection (GTR) group included 17 cases (53.1％) and the remaining 15 cases (46.9％) did not receive GTR.Out of the 12 patients of tumor recurrence,3 cases (25.0％) belonged to the GTR group and the other 9 cases (75.0％) were in the non-GTR group.The recurrence rates in the two groups (3/17 vs.9/15) were significantly different (P ＜0.05).Pathological results indicated that the "teratoma" components were contained in 22 cases,accounting for 66.8％ of all cases in this study and 84.6％ of non-germinoma of germ cell tumors (NGGCTs).In 2 cases of tumor recurrence,their pathological results were inconsistent with the original features.No severe surgical complications were observed.By the end of follow-up,6 patients (18.8％) died,among whom 5 did not receive postoperative chemoradiotherapy and died from tumor recurrence.Conclusions Microsurgery seems to be one important approach in treatment of ICGCTs,particularly NGGCTs.Patients might benefit from the GTR of the lesions.Individualized radiation and chemotherapy before and after surgery could help reduce the tumor recurrence.