睾丸肿瘤腹膜后淋巴结清扫术39例报告  

Retroperitoneal lymph node dissection for testicular cancer (report of 39 cases)

作　　者：叶定伟[1] 方银忠[1] 戴波[1] 顾卫列[1] 刘守业[1] 

机构地区：[1]复旦大学肿瘤医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2005年第4期283-285,共3页Chinese Journal of Urology

摘　　要：目的探讨腹膜后淋巴结清扫术(RPLND)在睾丸肿瘤治疗中的意义. 方法回顾性分析39例施行RPLND的睾丸生殖细胞肿瘤患者临床资料.年龄20～58岁,中位年龄29岁.左侧17例,右侧22例.精原细胞瘤1例,非精原细胞瘤38例.35例经CT、B超检查,提示15例腹部肿块,其中5例经博来霉素加鬼臼乙叉甙加顺铂方案化疗后肿块仍有残余,另有2例临床Ⅰ期患者经化疗后手术. 结果 10例临床Ⅰ期患者施行保留性神经的改良清扫术,余29例接受双侧手术.清扫组织未见癌转移者22例,癌转移17例,其中包括临床Ⅰ期4例.对RPLND证实有转移灶者和血AFP或β-HCG升高者均施行化疗.39例患者随访1～149个月,无瘤存活38例,接受保留性神经改良清扫术10例中射精功能恢复满意8例. 结论精原细胞瘤的诊断与随访中应警惕存在非精原细胞成分,必要时行RPLND.对于临床Ⅰ期非精原细胞瘤,应积极行保留性神经的改良RPLND术,病理Ⅱ期的患者术后应接受化疗.Objective To investigate the role of retroperitoneal lymph node dissection (RPLND) in the treatment of testicular cancer. Methods The clinical data of 39 cases (age range,20-58 years;median age,29 years) of germ cell tumor who underwent RPLND were retrospectively analyzed.Of the 39 cases,17 had the tumors on the left side and 22,on the right.One case was of seminoma,and the other 38 were of non-seminomatous germ cell tumor (NSGCT).According to the clinical examinations and radiology, 20 cases were of stage Ⅰ,15 of stage Ⅱ,and the rest 4 could not be staged. Results Of the 39 cases,10 with stage I tumors underwent nerve-sparing modified RPLND and the other 29 underwent bilateral RPLND.No metastasis was found in the dissected tissues in 22 cases,while metastasis,in 17 (including 4 of clinical stage I).All the patients with pathological metastases or elevation of blood tumor markers received postoperative chemotherapy.Follow-up was carried out for 1-149 months.The disease-free survival rate was 97.4%(38/39).Of the 10 cases receiving modified RPLND,8 regained their ejaculation function. Conclusions The probability of presence of the non-seminomatous components must be considered in the diagnosis and follow-up of seminoma cases,and the RPLND should be done if necessary.Nerve-sparing modified RPLND should be performed for clinical stage Ⅰ patients;while postoperative chemotherapy should be chosen for pathological stage Ⅱ patients.

关 键 词：睾丸肿瘤 腹膜后淋巴结清扫术 治疗 博来霉素 鬼臼乙叉甙 顺铂 

分 类 号：R737.21[医药卫生—肿瘤]