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.

Effect of testicular-sparing surgery for primary pediatric testicular teratoma in children

Objective To evaluate the therapeutic effect of testicular-sparing surgery for primary pediatric testicular teratoma in children.Methods The clinical data of 29 children with primary pediatric testieular teratoma between January 2001 and September 2007 was retrospectively analyzed.All patients were followed up at 6 months and 1 year postoperatively to evaluate the volume of testis by physical examination and B ultrasonography.Results All patients presented with a unilateral testicular mass.Mean age of patients at treatment was 43.9 months(ranging from 50 days to 12 years).A painless scrotal mass was the common symptom in all patients,which was proved to be an intratesticular mass by uhrasonography.The level of a fetoprotein(AFP)was below normal limits in 28 patients,while it was elevated in only one patient with the age of 50 days.Testicular-sparing surgery was performed in 21 cases(72%),while radicaI orchiectomy was performed in 8 cases with no normal testicular tissue in the mass.The pathologic diagnosis of primary testicular teratoma had no discordance between rapid frozen sections and postoperative paraffin section in all patients,including 27 mature and 2 immature teratomas.Average follow-up period in 29 patients was 49.7 months(ranging from 12 months to 92 months).There was no evidence of local or distant recurrence in all the patients.Twenty-one teratomas were successfully enucleated by testicular-sparing surgery with no postoperative testis atrophy.Conclusions Testicular-sparing surgery should be considered for primary pediatric testicular teratomas.The choice of treatment should be based on preoperative AFP and ultrasonography,as well as the intraoperative visual appearance of the lesion and the pathologic diagnosis of rapid frozen sections.