原发性睾丸肿瘤的诊断与治疗

目的：总结原发性睾丸肿瘤的诊断与治疗体会。方法：回顾性分析1990年1月－1999年10月收治的39例原发性睾丸肿瘤的临床资料，其中精原细胞瘤20例（51．3％），非精原细胞瘤18例（46．1％），恶性淋巴瘤1例（2．6％）。临床表现以睾丸无痛性肿大为主，B超为低回声或回声不均团块，CT和MRI对诊断腹膜后淋巴结转移及腹腔型隐睾恶变有重要价值。在根治性睾丸切除基础上采取腹膜后淋巴结清扫术、放疗、化疗等综合治疗措施。结果：30例获得随访，随访时间2－5年，随访率为76．9％。除2例Ⅲ期患者死亡外，其余均生存。结论：任何睾丸肿块均应排除肿瘤；B超应列为常规检查方法，CT和MRI有助于临床分期；肿瘤标记物对预后和疗效观察有一定参考价值；治疗方法应根据病理类型和临床分期而定。

Diagnosis and treatment of primary testicular neoplasms

To study the diagnosis and treatment of primary testicular neoplasms. Methods:39 cases of primary testicular neoplasms were analysed retrospectively. Results:There were 4,28 and 7 cases in the groups of 1～4 years (10.3％)、15～50 years (71.8％) and over 50 years (17.9％) respectively. 20 patients were semi noma (51.3 ％ ), 18 nonseminoma (46.1％ ), 1 lymphoma (2.6％ ). The cardinal clinical manifestation was painless solid enlargement of the testis. Ultrasonography demonstrated a hypoechoic or heterogeneous echoic mass. CT and MR could provide informations about the retroperitoneal metastasis lymph nodes and malignant changed ab dominal testis. Elevation of AFP and β-HCG noted in 50％ and 40％ of patients with nonseminomatous germ cell tumor? (NSGCT). Combined therapy, including radical orchiectomy、 retroperitoneal lymph node dissection (RPLND) ,radiation therapy and chemotherapy,were taken. 30 patients have been followed up for 2～5 years,2 of them died of distant metastasis. Conclusions: An intratesticular mass must be considered malignant until proved otherwise. Ultrosonography should be included a conventional examination. CT and MR scan is conducive to clinical staging. Tumor marks is helpful to predicting prognosis and monitoring therapeutic response. The choice of treatment is based upon the pathological type and clinical stage.