保留睾丸的肿瘤切除术治疗小儿良性睾丸肿瘤

摘要

目的 总结保留睾丸的肿瘤切除术治疗小儿良性睾丸肿瘤43例的临床经验.方法 2003年12月至2009年12月作者收治43例小儿良性睾丸肿瘤,年龄5个月至13岁,平均年龄4岁7个月.左侧28例(65％),右侧14例(33％),双侧1例(2％).多以阴囊内无痛性肿块或阴囊沉重感就诊.超声检查提示为畸胎瘤或表皮样囊肿,39例术前甲胎蛋白(AFP)正常,4例高于正常(正常值0～20 ng/mL).35例取阴囊切口,8例取腹股沟切口,切开睾丸白膜,完整剥离肿瘤,缝合睾丸.术后随诊5 ～88个月(平均33个月).结果 43例均采取保留睾丸的肿瘤切除术,切除瘤体包膜完整无破溃.术后病理诊断:成熟畸胎瘤27例(63％),不成熟畸胎瘤2例(5％),皮样囊肿12例(28％),单纯性囊肿2例(5％).40例获随访,无一例复发.结论 术前超声检查结合血清甲胎蛋白(AFP)测定可作为判断睾丸肿瘤性质的方法之一,对诊断为良性睾丸肿瘤者可采取保留睾丸的肿瘤切除术,预后良好；在辅助检查结果不确切的情况下需做术中睾丸病理检查.%Objective To summarize the curative effect of testis-sparing surgery in43 children with benign testicular tumors. Methods The clinical data of 43 children of benign testicular tumors from December 2003 to December 2009 in our hospital were retrospectively analyzed. Their age was range from 5 months to 13 years, mean 4 years 7 months, of 43 cases, 28 cases (65% ) were in left side, 14 cases (33% ) were in right side and 1(2%) in bilateral testis. Most of the pediatric patients presented with a painless scrota] mass or heavy sensibility of scortum. Preoperan've ultrasound revealed teratomas or epidermoid cysts, and of all cases, 39 cases with normal a-fetoprotein (AFP) level while 4 cases (age 5,6,7,10 months) with increased AFP (normal0-20 ug/mL). The surgery was via an scrotal incision(35cases) or an inguinal incision(8cases). An incision was made in the tunica albuginea and the mass was enucleated. Then we closed the remaining portion of the testis. We did follow-up 5 months to 88 months, mean 33 months after surgery. Results All of 43 cases were treated by testis-sparing surgery, and the encapsulation of tumor were completely. Among the 43 cases, there were 27(63% ) mature testicular teratomas, 2(5% ) immature testicular teratomas, 12(28% ) epidermoid cysts, 2(5% ) testicular simple cysts. 40 cases were followed up and without metastic or local recur- . _ rence. Conclusion Ultrasonography and AFP measurement are effective methods for differentiating malignant and benign testicular tumors before surgery. Testis-sparing surgery is positive method in the management of be- . nign testicular tumors in children and with well prognosis.