保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤

目的评价保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤的临床疗效。方法回顾性分析1998年10月到2009年3月收治的29例保留睾丸的肿瘤剜除术患儿临床资料。患儿平均发病年龄为42．6个月（4个月至12岁）,临床表现均为无痛性阴囊肿块,除1例术前AFP升高外,其余术前AFP均在正常范围。结果均行保留睾丸的肿瘤剜除术,术后病理诊断：21例为成熟性畸胎瘤,2例为表皮囊肿,4例为皮样囊肿,1例为囊肿性病变伴肉芽肿形成,1例为未成熟畸胎瘤（后行睾丸切除术）。25例冰冻切片均诊断为良性病变。21例B超下计算肿瘤体积为（1．25±2．05）mL,患侧睾丸体积（含肿瘤）为（4．56±5．07）mL,肿瘤占睾丸体积比例为（54．3±30．11）％（6．04％～100％）。7例最近1次门诊随访术侧平均睾丸体积为（0．78±0．31）mL,与健侧比较无统计学意义。20例平均获随访34个月（4～72个月）,无一例复发,患侧睾丸发育良好。结论保留睾丸的肿瘤剜除术可作为小儿睾丸良性肿瘤的首选治疗方法。     

保留睾丸手术治疗儿童睾丸畸胎瘤疗效观察

目的 评价保留睾丸手术治疗原发性儿童睾丸畸胎瘤的疗效.方法 对2001年1月～2007年9月收治29例原发性睾丸畸胎瘤患儿的临床资料进行回顾性分析.结果 29例患儿,均为单侧,平均发病年龄43.9个月(50 d～12岁).所有患儿均表现为患侧阴囊内无痛性肿块,且经术前B超证实.除1例50 d患儿的甲胎蛋白(AFP)超出正常范围外,其余28例的AFP检查结果均在正常范围内.29例患儿中21例(72%)行保留睾丸手术,其余8例因睾丸中无正常睾丸组织而行根治性睾丸切除术.所有病例术中冰冻与术后石蜡切片病理检查结果一致,均为睾丸畸胎瘤,其中成熟型27例,不成熟型2例(均行根治性睾丸切除).29例患儿术后随访至今,平均49.7个月(12～92个月).均未出现肿瘤复发、转移等并发症.21例保留睾丸组织的患儿术后B超随访患侧睾丸无萎缩.结论 原发性儿童睾丸畸胎瘤应首选考虑尽可能保留睾丸组织.治疗方法的选择有赖于术前AFP、B超以及术中对病变的评价、冰冻检查结果.     

核除术治疗小儿睾丸良性肿瘤

1994～2002年．我科收治29例小儿睾丸良性肿瘤(皮样囊肿6例．成熟畸胎瘤23例)，为探讨保留了睾丸的效果及意义，我们对核除术后的患儿，进行了随访观察，现报告如下。     

小儿睾丸畸胎瘤35例临床分析

目的总结小儿睾丸畸胎瘤的诊治经验。方法回顾性分析首都儿科研究所外科2001年6月-2013年4月收治的小儿睾丸畸胎瘤患儿35例,平均年龄3．6岁（1个月～10岁）。多以缓慢生长的阴囊无痛性肿块就诊,其中成熟畸胎瘤32例（91％）;不成熟畸胎瘤3例（9％）。结果全部患儿完整切除肿瘤,肿瘤切除率100％,其中保留睾丸手术33例（94％）,睾丸全切2例（6％）。术中冰冻切片病理检查与术后石蜡切片病理检查符合率100％。术后平均随访时间75（5～142）个月,均无复发,血清甲胎蛋白（AFP）正常,睾丸生长发育良好,无睾丸萎缩坏死发生。结论术前详细询问病史,仔细查体,AFP检测,B超、CT、MRI等影像学检查能够做出比较明确的临床诊断,术中冰冻病理检查有助于手术方式的选择;对于有部分正常睾丸组织的睾丸畸胎瘤患儿行保留睾丸手术是实用、可行的。     

小儿睾丸肿瘤23例诊治体会

目的 探讨小儿睾丸肿瘤的诊治方法.方法 回顾性分析深圳市儿童医院2005 ～ 2009年收治的23例睾丸肿瘤患儿临床资料,年龄2个月至9岁.多以无痛性阴囊肿块就诊.术前常规进行血清AFP、胸部CT、睾丸及腹膜后超声检查,睾丸MRI检查.采用高位精索离断式睾丸切除、睾丸瘤体剔除、腹膜后淋巴结清扫等术式,术中均行冰冻病理切片,术后根据瘤体性质进行相应化疗.随访6个月至5年,监测血清AFP动态变化,以及阴囊、腹股沟、腹膜后超声和胸片检查.结果 23例中,病理检查结果提示卵黄囊瘤11例,畸胎瘤8例,横纹肌肉瘤1例,精原细胞瘤1例,皮样囊肿2例.高位精索离断式睾丸切除术13例,睾丸肿瘤剔除术10例.获随访21例,平均随访时间19个月,卵黄囊瘤Ⅰ期9例,术后化疗1个疗程;Ⅱ期2例,术后1个月复查AFP阳性,PET检查提示阴囊残留复发1例,腹膜后转移1例.畸胎瘤8例,皮样囊肿2例,行保留睾丸的瘤体剔除术,均无瘤存活.结论 睾丸恶性肿瘤应行根治性睾丸切除术,卵黄囊瘤Ⅱ、Ⅳ期应采取手术加化疗.良性睾丸肿瘤可行肿瘤剔除术而保留睾丸组织.     

新生儿睾丸扭转临床回顾与分析

目的 探讨新生儿睾丸扭转的治疗措施选择.方法 回顾性分析11例新生儿睾丸扭转的诊治资料.分析评估内容包括临床表现、体格检查、辅助检查、治疗方法的选择以及术后随访情况等.结果 11例新生儿睾丸扭转,左侧6例,右侧5例;顺产8例,剖宫产3例;足月产10例,早产1例.产前睾丸扭转5例;产后睾丸扭转6例.产前睾丸扭转5例均行患侧睾丸切除,1例行对侧睾丸预防性固定术.所有产后睾丸扭转均行患侧睾丸切除+对侧睾丸预防性固定术.术后病理检查提示睾丸组织大部分出血伴坏死,其中5例产前睾丸扭转病例中4例病理检查提示睾丸组织有钙化灶.术后随访对侧睾丸未见明显异常.结论 对产前睾丸扭转,需切除患侧睾丸并同时行对侧睾丸固定.对双侧产前睾丸扭转,建议手术探查行睾丸扭转矫正术后保留睾丸.对产后睾丸扭转则需尽早安排手术探查并行预防性睾丸固定.     

保留睾丸的肿瘤切除术治疗小儿良性睾丸肿瘤

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—20ng／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。     

小儿睾丸肿瘤56例临床分析

目的总结56例睾丸肿瘤的诊治经验。方法回顾性分析1986年1月至2007年3月本院收治的56例小儿睾丸肿瘤的临床资料。其中53例以睾丸肿块就诊,1例以隐睾就诊,2例以血管瘤就诊。均经超声检查,33例行瘤标检测。56例中,24例为睾丸恶性肿瘤,采用睾丸切除、精索高位切除术;32例为睾丸良性肿瘤,其中2例行睾丸切除术,其余均单纯行肿瘤切除术。结果获随访的恶性睾丸肿瘤15例,时间为术后3个月至9年,2例Ⅳ期患儿分别在术后17个月和28个月死于肺转移和周身转移。18例良性睾丸肿瘤随访3个月至7.5年,无复发。结论早期诊断,早期手术是恶性睾丸肿瘤获得良好疗效的关键,术后积极化疗可提高疗效。对良性睾丸肿瘤应根据术中快速冰冻病理切片决定睾丸的取舍。     

新生儿睾丸扭转4例并文献复习

目的探讨新生儿睾丸扭转(neonatal testicular torsion,NTT)的诊断、鉴别诊断及治疗,提高对NTT的认识。方法 2015—2017年对无锡市儿童医院收治的4例新生儿睾丸扭转患儿的临床表现、体格检查、辅助检查、治疗方案及预后等资料进行回顾分析并复习相关文献。结果 4例患儿中3例生后即出现阴囊肿大,1例为生后8 d才出现,均为左侧,行急诊手术探查,术中均证实为睾丸扭转坏死,行患侧睾丸切除术,术后病理结果证实为睾丸坏死。术后随访6个月至2年,对侧睾丸无明显异常。结论 NTT患儿睾丸挽救率很低,对于怀疑NTT的患儿应及时行急诊探查手术。术中同时固定健侧睾丸是很有必要的,坏死的睾丸无论单侧还是双侧均建议术中切除。     

腹腔镜在分期Fowler-Stephens睾丸固定术中的应用

目的 探讨腹腔镜在分期Fowler-Stephens睾丸固定术中的应用。方法 应用腹腔镜对13例腹腔内睾丸的隐睾患儿，年龄1岁6个月-10岁，平均4.73岁，行Fowler-Stephens睾丸固定术的Ⅰ期手术，6-12个月后经腹股沟区行Fowler-Stephens睾丸固定术的Ⅱ期手术。结果 13例患儿中，11例已完成Ⅱ期睾丸固定术，经随访3个月-2年，睾丸均位于阴囊内，无睾丸萎缩，另外2例等待进行Ⅱ期Fowler-Stephens睾丸固定术。结论 腹腔镜分期Fowler-Stehens睾丸固定术是一种安全，可靠的手术方法，在治疗腹腔内睾丸的隐睾患儿中成功率明显高于其他手术方法。     

Prepubertal testicular tumors: frequently overlooked

ObjectivePrepubertal testicular tumors are fundamentally distinct from their adult counterparts. We reviewed our 10-year, two-institution experience with respect to diagnosis and treatment.Material and methodsA retrospective review was performed of all testicular tumors diagnosed between 1996 and 2006 in males younger than 14 years. We analyzed clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings and outcome.ResultsOf 15 primary testicular tumors, eight (53%) were germ-cell tumors (three teratomas, two yolk sac tumors, one seminoma, one embryonic carcinoma and one choriocarcinoma), four (27%) tumor-like lesions (epidermoid cysts), two (13%) gonadal stromal tumors (a Leydig and a Sertoli cell tumor), and one (7%) gonadoblastoma with gonadal dysgenesis. All boys were presented with a painless scrotal mass and four (27%) of them with elevated tumor markers. Ten cases (66%) were misdiagnosed by urologists preoperatively and presented for treatment of congenital or acquired scrotal disorders. Twelve children (80%) were treated with radical orchiectomy and three (20%) with a testis-sparing procedure. At a mean 4-year follow-up no patient has presented with recurrent tumor in the residual or contralateral testicle. Postoperative physical examination and scrotal ultrasound were obtained in 14 patients at a median follow-up of 48.2 months, and there was no evidence of tumor progression. One boy with a choriocarcinoma (stage IV) died due to distant metastases.ConclusionsBenign teratoma and epidermoid cysts were the most common prepubertal testicular tumors. Any suspicion of a testicular tumor warrants an inguinal approach to prevent scrotal violation of the tumor. Our limited experience with testis-sparing procedures supports the current trends that organ-confined surgery should be performed for benign lesions such as teratoma, Leydig cell tumor and epidermoid cysts based on frozen biopsy findings.     

Prepubertal testicular tumors in China: a 10-year experience with 67 cases

Aim

Prepubertal testicular tumors are rare in children. We aim to present clinical and histological features of prepubertal testicular tumors through the analysis of the long-term experiences of a single medical center of China.

Materials and methods

A total of 67 children (≤?14 years) treated for testicular tumor at our institution from 2005 to 2015 were retrospectively reviewed. Data relating the clinical characteristics, histopathology findings, serum tumor markers, treatment method, and outcome were collected.

Results

The patients’ median age at diagnosis was 18 months (range 3–168 months), and 49 cases (73.1%) were diagnosed at age younger than 3 years. The most common clinical presentation was a painless scrotal mass or swelling. Regarding histology, 32 (47.8%) were teratomas and only one of these tumors presents immature teratomas, 20 (29.9%) were yolk sac tumors, 9 (13.4%) were epidermoid cyst, 1 (1.5%) was a Leydig cell tumor, 1 (1.5%) was a mixed malignant germ cell tumor, and 4 (8.3%) were paratesticular tumors. For germ cell tumors, the mean preoperative serum α-fetoprotein (AFP) level was significantly higher in patients with yolk sac tumor than in those with teratomas (2,078 ng/mL vs 5.7 ng/mL). Of all these patients, 37 (55.2%) were treated with radical inguinal orchiectomy and testis-sparing surgery was planned and achieved in 30 (44.8%). Surveillance was performed in 60 patients. None of the patients developed recurrence or testicular atrophy after appropriate treatment.

Conclusions

The majority of our cases were benign, with the most common histopathological subtype being teratoma. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumor markers. This study shows a better outlook for prepuberty patient with testicular tumors than their adult counterparts.

     

Benign cystic lesions in the testis of children

Cystic lesions in the testis of children are rare and in most cases benign tumors. However, a preoperative diagnostic work-up could contribute to planning the surgical procedure: orchiectomy in the case of potential malignancy or otherwise a testis-sparing approach. In this study we reviewed our recent cases of benign cystic testicular tumors and the corresponding literature. The different entities are presented with details of the diagnostic work-up, pathology and treatment of these lesions. In all presented cases, organ-preserving treatment was performed. This practice is to be recommended in the case of all prepubertal cystic testicular lesions.     

Bilateral testicular teratoma in infancy: report of a rare case treated by testis-sparing surgery.

Testicular tumors are rarely seen in childhood, with germ-cell tumors as the most common type. Teratoma is second only to yolk sac tumor in frequency. Bilateral testicular teratoma is extremely rare. Orchiectomy has been the standard treatment for most tumors of the testes in the past. However, in children, testis-sparing surgery has become the treatment of choice for benign lesions including teratoma. A 10-month-old infant with synchronous bilateral testicular teratomas, one of which was disclosed by ultrasonography, is presented here. While the larger teratoma required unilateral orchiectomy, the smaller tumor in the contralateral testicle was enucleated by testis-sparing surgery. The follow-up at three years was uneventful with normal development of the testis and the boy. Testicular teratoma may reside in both testicles without clinical symptoms. Ultrasound of both testes provides coherent preoperative diagnosis, allowing the surgeon to consider testicular-sparing procedures, thus preventing anorchia in these rare occurrences.     

Splenic cysts in pediatric patients--a report on 8 cases and review of the literature.

8 cases of splenic cysts are reported: treatment was surgical in 4 large cysts (greater than 5 cm, 3 epidermoids and 1 pseudocyst), and non-operative in 4 small cysts (less than 5 cm, 3 post-traumatic pseudocysts and 1 congenital cyst, probably epidermoid). Follow-up was over a period of 3 months to 7 years. 3 among the 4 post-traumatic pseudocysts were followed up by ultrasound until resolution (3 months to 3 years), and 1 large pseudocyst was operated on due to rupture following benign trauma. 3 large cysts were epidermoid in origin, 1 was electively operated, and 2 were discovered and operated on because of complications (rupture, infection). Only one total splenectomy was performed; surgery preserved the spleen in all other cases; but 1 epidermoid cyst presents now with a recurrence. Based on this experience, we suggest frozen section of the cyst wall during surgery, to decide the type of partial splenectomy to be performed: total cystectomy or marsupialization.     

61例儿童睾丸卵黄囊瘤的诊断与治疗

目的：分析儿童睾丸卵黄囊瘤的诊断与治疗,以提高其临床诊治水平。方法回顾性分析本院1995年至2014年收治的61例儿童睾丸卵黄囊瘤患儿的临床资料。结果61例均以阴囊包块就诊,其中60例无痛;61例体查均有阴囊沉重感,透光试验均为阴性;3例提睾反射消失,6例误诊为鞘膜积液,4例初诊腹股沟疝,2例睾丸炎症,1例误诊为腺瘤。术前AFP值均增高,超声检查提示实性包块,CDFI提示84．8％睾丸肿块血流丰富。阴囊X线片均未见确切钙化影。60例行瘤睾高位切除术,1例行睾丸肿瘤剥除术,11例加行腹股沟区淋巴结清扫术。病理检查多见疏网状、腺泡样以及乳头样结构。2009年以前术后化疗采用博来霉素＋长春新碱,近5年采用PEB（顺铂＋足叶以带＋博来霉素）方案、PVB（顺铂＋长春新碱＋博来霉素）方案或二者交替化疗。术后1～2个月随访AFP值多降至正常,无一例复发或死亡。结论儿童睾丸卵黄囊瘤多因无肿痛性肿块就诊,体查包块有沉重感,AFP值升高,超声检查可见实质性包块。胸片和腹部超声可协助肿瘤临床分期。手术方案主要为高位瘤睾切除术,术中冰冻切片能协助术者选择手术范围,术后配合化疗,患儿临床预后效果好。