经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤  

Surgical treatment for stageⅠtesticular malignant germ cell tumors via scrotal incision

作　　者：贺敏[1] 蔡嘉斌[1] 茅君卿[1] 李民驹[1] 唐达星[2] 舒强[1] 王金湖[1] He Min;Cai Jiabin;Mao Junqin;Li Minju;Tang Daxing;Shu Qiang;Wang Jinhu(Department of Surgical Oncology,The Children's Hospital,Zhejiang University School Of Medicine,National Clinical Research Center For Child Health,Hangzhou,310000,China;Department of Urological Surgery,The Children's Hospital,Zhejiang University School Of Medicine,National Clinical Research Center For Child Health,Hangzhou,310000,China)

机构地区：[1]浙江大学医学院附属儿童医院、国家儿童健康与疾病临床医学研究中心肿瘤外科,杭州310000 [2]浙江大学医学院附属儿童医院、国家儿童健康与疾病临床医学研究中心泌尿外科,杭州310000

出　　处：《临床小儿外科杂志》2022年第7期643-647,共5页Journal of Clinical Pediatric Surgery

基　　金：浙江省自然科学基金(LQ20H160027)。

摘　　要：目的探讨经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤的可行性和安全性。方法收集浙江大学医学院附属儿童医院2014年1月至2019年12月收治的41例Ⅰ期睾丸恶性生殖细胞肿瘤患儿作为研究对象,按手术入路不同分为阴囊切口组(14例)和腹股沟切口组(27例)。收集两组患儿一般资料、手术时间、术后住院时间及术后并发症情况,并进行比较分析。结果41例均顺利完成手术。两组患儿年龄、体重、肿瘤直径、病理类型比较,差异无统计学意义(P>0.05)。阴囊切口组手术时间及术后住院时间分别为(39.3±9.2)min和(3.6±1.5)d,腹股沟切口组分别为(42.0±8.6)min和(4.3±2.2)d,两组之间差异均无统计学意义(P>0.05)。阴囊切口组患儿术前甲胎蛋白(alpha fetoprotein,AFP)值为(7203.9±16096.3)ng/mL,术后1个月为(21.2±14.0)ng/mL,术后2个月为(12.9±9.4)ng/mL。腹股沟切口组术前AFP值为(5048.8±8106.1)ng/mL,术后1个月为(32.2±41.3)ng/mL,术后2个月为(22.4±37.9)ng/mL。两组术后AFP较术前均明显降低,差异均有统计学意义(P<0.05)。两组各时间段AFP值比较差异均无统计学意义(P>0.05)。并发症方面,阴囊切口组有1例出现切口裂开,腹股沟切口组无一例围手术期并发症发生。两组术后随访时间分别为6~74个月和8~69个月,总体生存率均为100%;阴囊切口组和腹股沟切口组无病生存率分别为13/14和24/27,差异无统计学意义(P>0.05)。结论经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤可达到与传统腹股沟切口手术同样的临床疗效和预后,操作更简单,并发症可控,值得临床推广应用。Objective To explore the safety and feasibility of surgery for stageⅠtesticular malignant germ cell tumors via scrotal incision.Methods From January 2014 to December 2019,clinical data were retrospectively reviewed for 41 children with testicular malignant germ cell tumor without inguinal or retroperitoneal lymph node enlargement.The median age was 36(4-96)months.According to operative approach,they were divided into scrotal and inguinal groups.Perioperative related parameters and postoperative complications were compared between two groups.Results Both groups completed operations smoothly.No significant inter-group differences existed in age,body weight,tumor diameter or pathological type(P>0.05).Operative duration and postoperative hospitalization time of scrotal group were(39.3±9.2)min and(3.6±1.5)d respectively and that of groin group was(42.0±8.6)min and(4.3±2.2)d and the inter-group difference was not statistically significant(P>0.05).In scrotal group,preoperative value of alpha fetoprotein(AFP)was(7203.9±16096.3)ng/mL,(21.2±14.0)ng/mL at Month 1 post-operation and(12.9±9.4)ng/mL at Month 2 post-operation.In inguinal group,AFP value was(5048.8±8106.1)ng/mL pre-operation,(32.2±41.3)ng/mL at Month 1 post-operation and(22.4±37.9)ng/mL at Month 2 post-operation.After operation,AFP in both groups was significantly lower than that pre-operation with statistical significance(P<0.05).No significant inter-group difference existed in AFP value(P>0.05).In terms of complications,one case of incision dehiscence occurred in scrotal group while no perioperative complication was observed in inguinal group.The postoperative follow-up period of two groups was(6-74)(8-69)months.The overall survival rate was 100%and the event-free survival rate 13/14 and 24/27 without statistical significance(P>0.05).Conclusion Surgery via scrotal incision for stageⅠtesticular malignant germ cell tumors can achieve the same efficacy and prognosis as traditional inguinal incision.The operation is simple and the complications are c

关 键 词：生殖细胞瘤 睾丸肿瘤 阴囊/外科学 腹股沟/外科学 

分 类 号：R737.21[医药卫生—肿瘤]