小儿睾丸卵黄囊瘤合并鞘膜积液诊治分析(附7例报告)  

Diagnosis and treatment of yolk sac tumor of the testis with hydrocele in children: Report of 7 cases

作　　者：黄盛松[1] 吴登龙[1] 桂亚平[1] 赵鑫[1] 谢华[2] 

机构地区：[1]同济大学附属同济医院泌尿外科,上海200065 [2]上海交通大学附属儿童医院,上海200040

出　　处：《中华男科学杂志》2013年第11期1007-1010,共4页National Journal of Andrology

摘　　要：目的:提高小儿睾丸卵黄囊瘤的诊治水平,探讨小儿睾丸卵黄囊瘤合并鞘膜积液的临床特点及其中关联。方法:回顾性分析2008年9月至2012年4月收治7例睾丸卵黄囊瘤合并大量鞘膜积液患儿的临床资料。7例均初步诊断为睾丸卵黄囊瘤,临床Ⅰ期。术中快速病理证实为卵黄囊瘤后,行根治性高位精索睾丸切除术。7例术后随访时间3~41个月,按术后第1年每个月;第2年每3个月;第3年每6个月随访。内容包括常规体检、血清甲胎蛋白(AFP)、胸片、B超及CT。结果:7例术后病理均证实为睾丸卵黄囊瘤,未累及精索切缘端。6例术后1个月内血清AFP降至正常,诊断为临床Ⅰ期,未行化疗,无复发、转移;1例术后1个月血清AFP116μg/L,诊断为临床Ⅱ期,予PVB方案化疗,术后3个月失访。结论:小儿睾丸卵黄囊瘤合并鞘膜积液易于误诊,应常规检查B超。Ⅰ期患儿可单纯行根治性高位精索睾丸切除术,术后需密切随访;Ⅱ期患儿术后辅以联合化疗。目前尚无证据支持小儿睾丸卵黄囊瘤与鞘膜积液存在关联,其预后与同期病例相仿。[Abstract] Objective： To study the clinical characteristics of yolk sac tumor of the testis with concomitant testicular hydrocele in children and the association between the two conditions in order to improve the diagnosis and treatment of the disease. Methods ： We retrospectively analyzed the clinical data of 7 cases of stage-I yolk sac tumor of the testis with concomitant testicular hydrocele. The patients ranged in age from 6 to 14 （mean 11 ） months. As treatment, we performed radical high spermatic cord orchiectomy after diag- nosis established on intraoperative frozen sections, and conducted follow-up visits by medical examination, serum alpha-fetoprotein （AFP） detection, chest X-ray, uhrasonography and CT for 3 - 41 （ mean 17） months, every month in the first year, every 3 months in the second year and every 6 months in the third year after surgery. Results： Postoperative pathology confirmed yolk sac tumor in all the cases, with negative incisal margin. The level of serum AFP were decreased to normal in 6 cases within 1 month after surgery, all diagnosed as at stage I, and cured without chemotherapy. The other 1 case, with the serum AFP level of 116 I^g/L at 1 month after op- eration, was diagnosed as at stage II and received PVC chemotherapy, but lost to follow-up at 3 months post-operatively. Conelu- s/on ： Yolk sac tumor of the testis with concomitant testicular hydrocele is easily misdiagnosed in children. Ultrasonography is necessita- ted as routine examination in its diagnosis. Radical high spermatic cord orchiectomy can be performed for patients in stage I, and chemo- therapy should follow for those in stage II. Its prognosis is similar to that of other yolk sac tumors. Hitherto, there has been no evidence for a definitive correlation between yolk sac tumor of the testis and hydrocele in children. Nati J Androl, 2013, 19 （11） ： 1007 -1010

关 键 词：睾丸肿瘤 卵黄囊 睾丸鞘膜积液 儿童 

分 类 号：R737.21[医药卫生—肿瘤] R697.23[医药卫生—临床医学]