小儿睾丸卵黄囊瘤诊治分析  

The diagnosis and treatment of testicular yolk sac tumors in children

作　　者：王岩岗[1] 蒲春林[1] 罗勇[1] 李九智[1] 文彬[1] 

机构地区：[1]新疆自治区人民医院泌尿外一科,乌鲁木齐830001

出　　处：《国际泌尿系统杂志》2013年第1期27-31,共5页International Journal of Urology and Nephrology

摘　　要：目的探讨小儿睾丸卵黄囊瘤的诊治方法。方法本组12例，年龄2个月～8岁。多以无痛性阴囊肿块就诊。术前常规进行血清AFP检查，胸片和（或）胸部CT检查，阴囊和腹膜后超声检查，睾丸MRI检查。术中冷冻病检了解肿瘤性质，决定手术方式。采用高位精索离断式睾丸切除，术后根据瘤体性质进行相应的化疗，必要时行腹膜后淋巴结清扫术。术后随访3个月～2年，监测血清AFP动态变化，并行阴囊、腹股沟、腹膜后超声检查和胸片检查。结果本组12例，病理结果均为卵黄囊瘤。高位精索离断式睾丸切除11例，睾丸肿瘤剔除术1例。卵黄囊瘤I期12例，10例术后化疗一个疗程，睾丸肿瘤剔除术1例术后拒绝化疗，l例因为经济困难未行化疗，术后6个月肝肺腹盆腔、骨骼转移、后腹膜淋巴结广泛转移压迫下腔静脉致布加氏综合征，放弃治疗；l例术后1个月复检AFP再次阳性，PET检查提示阴囊残留复发（再次手术），腹膜后转移1例，并行腹膜后淋巴结清扫。12例获随访，平均随访16个月。结论卵黄囊瘤I期宜行高位精索离断式睾丸切除术，Ⅱ期以上应考虑行腹膜后淋巴结清扫，术后宜配合化疗。Objectives To explore the diagnosis and treatment of testicular yolk sac tumors in children. Methods The clinical data of 12 cases （aged between 2 months to 8 years） with testicular yolk sac tumors was retrospectively analyzed. Most of children presented with painless scrotal mass. All cases accepted the serum alpha - fetoprotein （AFP） measurement, chest slice and（or） chest CT scan, testicle Magnetic Resonance Imaging （MRI） check, testicular and retroperitoneal uhrasonography. In order to determine procedures of surgical operation, testicu- lar tumors were frozen sectioned to perform pathological examination during operation. Chemotherapy was performed according to the character of tumour after operation. Most patients underwent orchiectomy, while retroperitoneal lymph node resection was performed in certain circumstance. All cases were followed up for about 3 months to 2years postop- eratively, with surveillance of AFP, testicular and retroperitoneal ultrasonography, and chest X - ray. Results Pathology the result is all YST Of the 12 cases, 11 cases underwent high ligation and spermatic testicular resection, andl case underwent testicular sparing enucleation surgery, and 12 cases were followed up, mean time 16 months, and 10 cases （stage I ） accepted one course of chemotherapy, 1 case refuses a chemotherapy after testicular sparing enucleation surgery, 1 case because the financial straits didnl go a chemotherapy, postoperatively 6 month the liver lung abdomen pelvic cavity, skeleton metastasis, retroperitoneal lymph the knot extensively metastasis to oppress in- ferior vena cava result to inferior vena cava obstruction syndrome, give up a treatment; 1 cases under - went reopera- tion and re - chemotherapy because of AFP , PET check hint the scrotum remain to relapse（ again surgi- cal operation） tumors recrudescence, and 1 case retroperitoneal metastasis. Conclusions Children with tesitcu- lar yolk sac tumors in stage I can be managed with high ligation and spermatic testicular resection,

关 键 词：睾丸肿瘤 

分 类 号：R737[医药卫生—肿瘤]