成人睾丸畸胎瘤诊疗分析(附10例报告)  

Treatment of adult testicular teratoma(Report of ten cases)

作　　者：张忠云[1] 孙忠全[1] 钱伟庆[1] 张正望[1] 沈志远[1] 宋建达[1] 

机构地区：[1]复旦大学附属华东医院泌尿外科,上海200040

出　　处：《临床泌尿外科杂志》2016年第4期314-316,320,共4页Journal of Clinical Urology

摘　　要：目的：探讨成人睾丸畸胎瘤的诊治方法和效果。方法：我院2003年1月-2013年10月收治成人睾丸畸胎瘤患者10例,包括纯畸胎瘤4例,混合性生殖细胞肿瘤含畸胎瘤成分6例;临床分期Ⅰ期2例,Ⅱa期1例,Ⅱb期2例,Ⅱc期2例,Ⅲ期3例。患者基本按照指南推荐的方案进行治疗,行根治性睾丸切除术并化疗,密切随访。结果：1例Ⅰa期患者密切随访;6例Ⅰb期和Ⅱ期患者行腹膜后淋巴结清扫术和（或）化疗,均取得良好效果;3例Ⅲ期患者化疗后瘤标一度下降,之后上升,其中1例大剂量化疗＋自体造血干细胞移植后缓解,1例大剂量化疗＋自体造血干细胞移植后死亡,1例局部治疗（HIFU）后死亡。10例畸胎瘤患者目前随访2-12年（中位数4年）,死亡2例（20.0%）,其余患者（80.0%）经治疗后均无进展。结论：成人睾丸畸胎瘤有恶性行为,应积极治疗;畸胎瘤是一种特殊的非精原细胞瘤,对放化疗不敏感,手术是唯一有效的治疗方法,按照指南推荐的方法进行治疗,可取得较好疗效。Objective：To evaluate the effect of surgery and chemotherapy for adult testicular teratoma.Method：The clinical and follow-up data of ten cases of adult testicular teratoma from Jan.2003 to Oct.2013 were retrospectively studied.There were four cases of pure teratoma and six cases of mixed nonseminomatous germ-cell tumors which has teratomatous element.According to the clinical staging of testicular cancer,we diagnosed two cases of phaseⅠ,one case of phaseⅡa,two cases of phaseⅡb,two cases of phaseⅡc,three cases of phaseⅢafter orchiectomy.And we treated them mainly with retroperitoneal lymph node dissection（RPLND）and/or chemotherapy based on the guidelines of testicular cancer.All patients were closely followed up.Result：One case of phaseⅠa was closely followed up.Six cases of phaseⅠband Ⅱ received RPLND and/or chemotherapy and achieved good treatment effect.Three cases of PhaseⅢ did not get relieved after four cycles of BEP chemotherapy.One of them got relieved after high-dose chemotherapy plus stem cell transplantation,another one case died after high-dose chemotherapy plus stem cell transplantation,and the rest one died after local treatment of HIFU.So all ten cases,two（20%）cases died,eight（80%）cases got relieved during 2-12（median,4）years of follow-up period.Conclusion：Adult testicular teratoma has malignant features similar to other germ cell cancers,but it is resistant to chemotherapy and radiation.Patients can＇t achieve good effect until they are managed with surgical resection based on the guidelines of testicular cancer.

关 键 词：睾丸肿瘤 畸胎瘤 化疗 腹膜后淋巴结清扫术 

分 类 号：R737.25[医药卫生—肿瘤]