睾丸内胚窦瘤的诊断及治疗

Diagnose and treatment of testicular endodermal sinus tumor

目的探讨睾丸内胚窦瘤的诊断及治疗方式。方法睾丸内胚窦瘤患者24例。年龄5个月～33岁，中位年龄20个月，其中〈2岁者15例、2～14岁者5例、〉14岁者4例。症状为睾丸肿大20例，腹痛、腹部包块2例，反复咳嗽2例。血清甲胎蛋白（AFP）升高率85％（17／20）。术前分期：Ⅰ期18例，Ⅱ期4例，Ⅲ期2例。24例均行患侧睾丸根治性切除术，8例加行腹膜后淋巴结清扫术；术后辅以化疗。结果组织学表现为网状结构23例（96％）、透明小体22例（92％）、腺样结构20例（83％）、内胚窦样结构16例（67％）和实体状结构13例（54％）。术后患者血清AFP均下降，2例再次升高，均发现复发或转移。21例随访20个月～12年。死亡2例，其中1例Ⅰ期患者术后2年死于肺部转移及脊椎转移，1例Ⅲ期患者术后1年死于全身转移。无瘤生存19例，其中存活1年～者5例、3年～者6例、5年～者4例、10年～者4例。8例存活≥5年者均为Ⅰ期患者。结论早期诊断、采用睾丸根治性切除术及化疗等综合治疗是提高睾丸内胚窦瘤疗效的关键。AFP可作为诊断及判断早期复发的指标。

Objective To investigate the diagnosis and treatment outcomes of testicular endodermal sinus tumor. Methods Twenty-four cases diagnosed with testicular endodermal sinus tumors from November 1996 to April 2007 were retrospectively reviewed. Eighteen patients presented with stage Ⅰ disease, 4 presented with stage Ⅱ , and 2 presented with stage Ⅲ. Inguinal radical orchiectomy were performed in all patients. Retroperitoneal lymph node dissection was performed in 8 cases. Results The histological structures were rather complicated in 24 tumors. Twenty three cases （96%） were found with reticular pattern, 22（92%） with hyaline body, 20 （83%） with glandlike structure, 16 （67 %） with Shiller-Dural hody, and 13 （54 %） with solid formation. The former 3 kinds were regarded as the main diagnostic criteria. Twenty-one cases were followed up for 20 months to 12 years. During the follow-up, 2 patients died of the disease. Conclusions Early diagnosis and combination therapy, including radical orchiectomy and chemotherapy, are the keys to improve the curative effect of testieular endodermal sinus tumors. Active surveillance of AFP is critical for monitoring the recurrence and metastasis of this tumor.