保留神经腹膜后淋巴结清除术治疗睾丸肿瘤  

Nerve-sparing retroperitoneal lymph node dissection for testicular cancer (report of 13 cases)

作　　者：刘卓炜[1] 丘少鹏[2] 周芳坚[1] 梅骅[2] 秦自科[1] 韩辉[1] 

机构地区：[1]中山大学肿瘤防治中心泌尿外科,广州510060 [2]中山大学附属第一医院泌尿外科

出　　处：《中华泌尿外科杂志》2005年第7期491-493,共3页Chinese Journal of Urology

摘　　要：目的探讨保留神经腹膜后淋巴结清除术(RPLND)在低期睾丸肿瘤治疗中的作用和效果。方法1999年6月至2003年7月收治睾丸肿瘤患者13例,年龄24～41岁,平均29岁。肿瘤位于左侧9例,右侧4例,大小2cm×3cm×2cm～9cm×6cm×5cm。临床分期:Ⅰ期11例,均为非精原细胞瘤;ⅡA期1例,为畸胎瘤(CT示腹膜后转移灶1cm×2cm);ⅡC期1例,为精原细胞瘤(CT示腹膜后转移灶10cm×9cm)。12例非精原细胞瘤者根治性睾丸切除术后1～4周行保留神经RPLND,1例精原细胞瘤者根治性睾丸切除术后行3疗程BEP方案化疗后行保留神经RPLND。结果术后病理分期:Ⅰ期11例,ⅡA期2例,其中ⅡC期精原细胞瘤患者化疗后分期降为Ⅰ期。13例术后均无肠梗阻、淋巴瘘和体位性低血压。术后2周复查时血AFP和βHCG均降至正常范围。术后8～12周均恢复射精功能。随访18～64个月,平均39个月,无肿瘤复发或转移。结论对于青壮年患者,保留神经RPLND是治疗低期非精原细胞瘤和化疗后降期的精原细胞瘤的首选方法。Objective To evaluate the efficacy of nerve-sparing retroperitoneal lymph node dissection(RPLND) for low stage testicular cancer. Methods The clinical data of 13 patients (mean age,29 years;age range,24-41 years) with testicular cancer who had undergone nerve-sparing RPLND were reviewed. The testicular cancers were 2 cm×3 cm×2 cm to 9 cm×6 cm×5 cm in size,and were on the left in 9 cases,on the right in 4.Of the 13 cases,11 had clinical stage I non-seminomatous germ cell tumors (NSGCT),1 had clinical stage IIA teratoma,and 1 had stage IIC seminoma.Twelve cases of NSGCT underwent radical orchiectomy;1 to 4 weeks after the operation,nerve-sparing RPLND was performed on them.One case of seminoma underwent radical orchiectomy and then received postoperative chemotherapy (3 cycles of BEP regimen);after that RPLND was performed on him. Results Pathological stage (PS) I disease was found in 11 cases and PS ⅡA disease in 2. There were no intraoperative and postoperative complications.Serum AFP and beta-HCG were decreased to normal when examined 2 weeks after operation.And ejaculation was recovered in all of them 8-12 weeks after operation. After follow-up for 18 to 64 months (mean,39 months),there was no recurrence or metastasis in all the patients.Serum AFP and beta-HCG were staying in normal range.All the patients maintained antegrade ejaculation. Conclusions Nerve-sparing RPLND can be performed with satisfactory results in patients with low stage NSGCT and post-chemotherapeutic seminoma. And it is a reasonable choice for young patients.

关 键 词：腹膜后淋巴结清除术 保留神经 睾丸肿瘤 非精原细胞瘤 2003年7月 术后病理分期 体位性低血压 切除术后 1999年 BEP方案 β-HCG 青壮年患者 化疗后 肿瘤治疗 肿瘤患者 临床分期 正常范围 血AFP 射精功能 肿瘤复发 转移灶 

分 类 号：R737.21[医药卫生—肿瘤]