儿童睾丸旁肿物的诊治分析(附27例报告)  

Diagnosis and treatment of paratesticular tumor in children: a report of 27 cases

作　　者：许帅 张潍平[1] 孙宁[1] 李明磊[1] 田军[1] 宋宏程[1] Xu Shuai;Zhang Weiping;Sun Ning;Li Minglei;Tian Jun;Song Hongcheng(Department of Urology Surgery,Affiliated Beijing Children's Hospital,Capital Medical University,National Children's Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《中华小儿外科杂志》2023年第10期927-930,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结儿童睾丸旁肿物的诊治经验,以期提高儿童睾丸旁肿物术前诊断水平,制定合理个体化治疗方案。方法回顾性分析2010年1月至2021年5月经北京儿童医院手术治疗的27例睾丸旁肿物患儿临床资料。患儿平均年龄为7.4岁,范围为0.3~14.5岁。肿物位于左侧12例,右侧14例,双侧1例。患儿术前均接受体格检查及超声检查。自发现睾丸旁肿物至接受手术的平均时间为4.5个月,范围为1周至3年。患儿经腹股沟切口精索高位结扎瘤睾切除术8例,经腹股沟切口保留睾丸睾丸旁肿物切除术1例,经阴囊切口保留睾丸单纯睾丸旁肿物切除术18例。6例睾丸旁横纹肌肉瘤患儿均无淋巴结及远处转移,均按低危组以长春新碱+放线菌素D+环磷酰胺组合化疗;1例白血病转移患儿术后继续化疗;其余患儿术后未予其他治疗。结果病理结果为良性肿物17例,恶性肿瘤10例。良性肿物包括附睾囊肿10例,脾组织(脾性腺融合)1例,肾上腺残基瘤1例,附睾平滑肌瘤1例,婴儿纤维性错构瘤1例,附睾纤维性假瘤1例,脂肪母细胞瘤1例,淋巴管瘤1例。恶性肿瘤包括睾丸旁横纹肌肉瘤(胚胎型)6例,黑色素神经外胚层肿瘤1例,高分化脂肪肉瘤1例,白血病转移瘤1例,节细胞神经母细胞瘤转移瘤1例。术前临床诊断与病理基本符合。所有患儿均获得随访,平均随访时间为5.8年,范围为5个月至11年5个月。除1例节细胞神经母细胞瘤转移瘤患儿术后6个月左侧面部肿瘤复发,再行手术外,其余患儿均未复发。结论对于儿童睾丸旁肿物的治疗,需结合病史、实验室及影像学检查综合判断,尽可能术前明确诊断,以免延误恶性肿瘤的治疗时机。Objective To improve the preoperative diagnosis of paratesticular tumor in children and to formulate an optimal and individualized treatment protocol.Methods A total of 27 children of paratesticular tumor undergoing operations were reviewed retrospectively.The average age was 7.4(0.3-14.5)years.Tumor was located at left(n=12),right(n=14)and bilateral(n=1).All of them received preoperative physical and ultrasonic examinations.The average time from a discovery of testicular mass to surgery was 4.5 months(1 week to 3 years).Eight children underwent high ligation of spermatic cord through an inguinal incision during tumor orchiectomy.One child underwent resection of testicular para testicular masses through an inguinal incision.And 18 cases underwent resection of testicular simple para testicular masses through a scrotal incision.Without lymph node or distant metastasis,6 low-risk children of parathyroid rhabdomyosarcoma received a combination of vincristine,actinomycin D and cyclophosphamide.One case of leukemic metastasis continued postoperative chemotherapy.The remainders received no further postoperative treatment.Results The pathological examinations revealed benign(n=17)and malignant(n=10)tumors.Benign tumors included epididymal cyst(n=10),adrenal residual tumor(n=1),epididymal leiomyoma(n=1),infantile fibrous hamartoma(n=1),epididymal fibrous pseudotumor(n=1),lipoblastoma(n=1),splenic gland fusion(n=1)and lymphangioma(n=1).Malignant tumors(n=10)included paratesticular rhabdomyosarcoma(embryonic type)(n=6),infantile melanotic neuroectodermal tumor(n=1),well-differentiated liposarcoma(n=1),leukemic metastasis(n=1)and ganglionic neuroblastoma metastasis(n=1).The preoperative clinical diagnosis was basically consistent with the pathology.During an average follow-up period of 70(5-137)months,only 1 child of metastatic ganglioblastoma was re-operated for tumor recurrence on left face at Month 6 postoperatively.Conclusions For paratesticular tumors in children,it is necessary to make a comprehensive judgment based up

关 键 词：泌尿生殖系统肿瘤 诊断 治疗 儿童 

分 类 号：R737.21[医药卫生—肿瘤]