152例睾丸肿瘤的临床诊治分析

目的探讨睾丸肿瘤的诊断、治疗及预后情况。方法回顾性分析我院2002年1月至2012年2月收治的152例睾丸肿瘤患者的临床资料。患者年龄46天～83岁，平均38．i岁，左侧75例，右侧74例，双侧3例。其中年龄〈20岁者24例，〉60岁者29例，20～60岁者99例；临床表现以睾丸肿块为主122例，伴睾丸坠胀疼痛22例，腹部包块者8例，睾丸透光试验阴性者148例，合并隐睾21例。根据睾丸肿瘤临床分期标准：Ⅰ期115例，Ⅱ期26例，Ⅲ期11例。136例行手术治疗，其中行根治性睾丸切除术124例，病理明确为精原细胞瘤接受放疗73例，为非精原细胞瘤再行腹膜后淋巴结清扫术16例；同期行根治性睾丸切除术加腹膜后淋巴结清扫术12例，3例淋巴瘤为病理活检取得，淋巴瘤患者转科行化疗或放疗，病理证实而放弃治疗病例3例。结果病理证实精原细胞瘤97例，睾丸淋巴瘤13例，混合性生殖细胞瘤11例，成熟畸胎瘤9例，非成熟型畸胎瘤5例，卵黄囊瘤5例，睾丸间质细胞瘤5例，胚胎癌3例，睾丸胚胎型横纹肌肉瘤2例，睾丸网状腺癌1例，睾丸黏液腺癌1例。术后随访13～90个月，失访21例，随访的精原细胞瘤患者i、5年生存率分别为95．5％（85／89）和85．4％（76／89）；非精原细胞瘤患者42例，1、5年生存率分别为81．0％（34／42）和54．8％（23／42），随访死亡患者均死于肿瘤转移或复发。结论睾丸肿瘤的预后与病理类型、分期和治疗方式均有关，精原细胞瘤预后最佳，混合性生殖细胞瘤预后较好。对精原细胞瘤患者可采用根治性睾丸切除术或手术加放疗；非精原细胞瘤宜行根治性睾丸切除术加腹膜后淋巴结清扫术等综合治疗。早期诊断及治疗对睾丸肿瘤的预后有重要意义。

The clinical treatment analysis of 152 cases of testicular tumor

Objective To explore the diagnosis, treatment and prognosis of testicular tumor. Methods The clinical and followed data of 152 cases of testicular tumor from Jan. 2002 to Feb. 2012 were retrospectively studied. Patient age ranged from 46 days to 83 years, mean 38.1 years. 75 cases were on the left side, 74 cases the right side, 3 cases bilateral. 24 patients were younger than 20 years old, 29 patients older than 60 years, the other 99 patients were between 20 to 60 years of age. 122 patients manifested as a testicular mass, 22 cases of testicular bulge pain, 8 cases abdomi- nal, 148 cases with negative testicular and light test, 21 cases combined cryptorchidism. According to the clinical staging of testicular cancer, 115 cases were diagnosed with Phase Ⅰ , 26 cases with Phase Ⅱ , 11 cases with Phase Ⅲ. Of the 136 surgical patients, 124 patients received radical orchiec- tomy, 73 cases with seminoma were treated with radiotherapy and 16 patients with non-seminoma were treated with peritoneal lymph node dissection. 12 cases were treated with radical testieular re- section and retroperitoneal lymph node dissection simultaneously. Three lymphoma patients were di- agnosed after biopsy. All the lymphoma patients were treated with chemotherapy or radiotherapy. 3 patients abandoned the treatment. Results There were 97 cases of testicular seminoma, 13 cases of testicular lymphoma, 11 cases of mixed germ cell tumors, 9 cases of mature teratoma, 9 cases of non-mature teratoma, 5 cases of yolk sac tumor, 5 cases of testicular interstitial cell tumor, 3 casesof emhryonal carcinoma, 2 cases of testicular embryonal rhabdomyosarcoma, 1 case of testicular mesh adenocarcinoma, 1 case of testicular mucus adenocareinoma. All patients were followed up for 13 months to 90 months, 21 cases were lost. The 1, 5 year survival rates of seminoma were 95.5% （85/89） and 85.4% （76/89）. The l, 5 year survival rates of non-seminoma were 81.0% （34/42） and 54.8% （23/42）. All patients died of tumor metastasis or recurrence. Conclusions Prognosis of testicular cancer related to histological type, staging and treatment. Prognosis of seminoma were better than mixed germ cell. tumors. The treatment of testicular seminoma was radical orchiectomy surgery com- bining radiotherapy. The treatment of non-seminoma tumors was radical orchiectomy combining retroperito- neal lymph node dissection. Early diagnosis and early treatment were the two most important factors af- fecting the survival of patients with testicular tumor.