双侧睾丸肿瘤的诊疗策略

Strategy for the diagnosis and treatment of bilateral testicular tumor

目的探讨双侧睾丸肿瘤的临床特点及诊疗对策。方法回顾分析1980年1月至2004年12月收治10例双侧睾丸肿瘤患者的症状、体征、影像学、肿瘤标志物、治疗方式和病理资料。年龄19～58岁,平均34岁。双侧同时性癌2例,癌均为Ⅰ期病变。异时性癌8例,初发肿瘤Ⅰ期5例、Ⅱ期3例,对侧肿瘤Ⅰ期6例、Ⅱ期1例、Ⅲ期1例。初次肿瘤精原细胞瘤4例,对侧肿瘤精原细胞瘤3例。结果2例同时行双侧根治性睾丸切除术,8例先后行根治性睾丸切除术,后腹膜淋巴结清除术3例。术后10例出现不同程度的继发雄激素缺乏综合征,7例行雄激素替代疗法。10例随访9个月～23年,平均10．5年,死亡2例,转移2例(1例带瘤生存),局部复发2例,行肿瘤局部切除术。结论双侧睾丸肿瘤异时性多见,常见病理类型为精原细胞瘤,可以选择性行保留睾丸手术。

Objective To evaluate the clinical features and the strategy for the diagnosis and treatment of bilateral testicular tumor. Methods The clinical data （ including the signs and symptoms,imaging studies,tumor markers,treatment modalities and histopathologic diagnoses） of 10 cases of bilateral testicular tumor from January 1980 to December 2004 were reviewed. Their age ranged from 19 to 58 years（ mean,34 years）. Of the 10 cases, 8 with metachronous and 2 with synchronous testicular tumors were identified. The clinical stages at the primary and secondary tumor diagnosis were：5 cases of stage Ⅰ ,3 of stage Ⅱ ;and 6 cases of stage Ⅰ ,1 of stage Ⅱ ,and 1 of stage Ⅱ ,respectively,in 8 metachronous tumor patients. Two synchronous tumor patients were both identified as stage Ⅰ disease. Histological examination showed the primary tumor （seminoma） in 4 cases and the secondary contralateral tumor （seminoma） in 3, Results Two synchronous tumor patients underwent bilateral radical orchiectomy simultaneously,and 8 underwent orchiectomy successively, Retroperitoneal lymph node dissection was performed in 3 cases, Postoperatively, hypogonadism occurred in 10 patients, and 7 of them received androgen replacement therapy. Follow-up ranged from 9 month to 23 years with a mean of 10, 5 years, Two patients died of the disease;2 had metastasis （ 1 of them was alive with metastasis） ;2 had recurrences and underwent local resection, Conclusions Metachronous bilateral testicular cancers are more common than synchronous bilateral testicular cancers. Seminoma was the most common histopathologic type, Testis-sparing surgery can be performed in selected cases.