双侧睾丸肿瘤的选择性手术切除(附1例报告并文献复习)

Organ preserving surgery on bilateral testicular germ cell tumour (Report of one case)

目的探讨双侧睾丸肿瘤(BTGCT)手术方法选择和睾丸部分切除术的临床应用。方法对1例两侧先后发生的BTGCT患者,一侧行睾丸根治性切除术8年后,知情同意下,对另一侧选择冷缺血保留睾丸功能的睾丸部分切除术;术后常规行局部放疗,根据病理进行化疗。结果术后病理为精原细胞癌为主,混合胚胎癌成份,已随访24个月,性激素水平除FSH偏高外均正常,勃起功能正常,β-HCG和AFP在正常范围;B超、MRI复查未见复发。结论对一侧睾丸肿瘤且对侧睾丸有肿瘤发生高风险因素的患者,应该坚持终生密切随访;BTGCT患者可选择保留睾丸功能的睾丸部分切除术,术后局部放疗18Gy左右,可不行激素替代治疗,远期疗效仍需密切随访。

Objective： To evaluate the alternative of operation methods and the indications about the BTGCT （Bilateral Testicular Germ Cell Tumour）, we introduce the alternative enucleation resection of organ preserving operation on BTGCT. Methods：On our institute, one case of metachronous BTGCT was alternative performed the organ preserving surgery under cold ischemia with the signed informed consent. Results：The pathology were mainly seminoma with parts of embryomal carcinoma recur by B ultrasonography and MRI on every three months year＇s routine component. After we did follow-up twenty-four months, the testosterone were normal range except the high of FSH,and the erectile function was normal, β-HCG and AFP were declined to normal range, there were no local checkup. Conclusions：It should be follow up a life long term for those patients of testicular tumor, especially the high risk factors one. The BTGCT with normal sexual hormones level could alternative perform the cold ischemia enucleation resection of organ preserving operation, then radiotherapy by 18Gy or so. It may avoid life long androgen replacement , keep the normal sexual hormones level and erect function, and possibly preserve fertility, this case＇s long term effect needs further observation and follow up.