61例儿童睾丸卵黄囊瘤的诊断与治疗

The diagnosis and treatment of testicular yolk sac tumors in children

目的：分析儿童睾丸卵黄囊瘤的诊断与治疗，以提高其临床诊治水平。方法回顾性分析本院1995年至2014年收治的61例儿童睾丸卵黄囊瘤患儿的临床资料。结果61例均以阴囊包块就诊，其中60例无痛；61例体查均有阴囊沉重感，透光试验均为阴性；3例提睾反射消失，6例误诊为鞘膜积液，4例初诊腹股沟疝，2例睾丸炎症，1例误诊为腺瘤。术前AFP值均增高，超声检查提示实性包块，CDFI提示84．8％睾丸肿块血流丰富。阴囊X线片均未见确切钙化影。60例行瘤睾高位切除术，1例行睾丸肿瘤剥除术，11例加行腹股沟区淋巴结清扫术。病理检查多见疏网状、腺泡样以及乳头样结构。2009年以前术后化疗采用博来霉素＋长春新碱，近5年采用PEB（顺铂＋足叶以带＋博来霉素）方案、PVB（顺铂＋长春新碱＋博来霉素）方案或二者交替化疗。术后1～2个月随访AFP值多降至正常，无一例复发或死亡。结论儿童睾丸卵黄囊瘤多因无肿痛性肿块就诊，体查包块有沉重感，AFP值升高，超声检查可见实质性包块。胸片和腹部超声可协助肿瘤临床分期。手术方案主要为高位瘤睾切除术，术中冰冻切片能协助术者选择手术范围，术后配合化疗，患儿临床预后效果好。

Objetive To explore the diagnosis and treatment of testicular yolk sac tumors in children and improving our current diagnostic and treatment level. Methods The clinical data of 61 cases with testicu-lar yolk sac tumor from 1 995 to 201 4 in Chongqing medical university affiliated children ’s hospital. Results 61 cases presented with scrotal mass （60 painless、bearing down1 00%、cremasteric reflect posi-tive1 00%）.6 cases were misdiagnosed as hydrocele,4 inguinal hernia,2 testicular inflammation and 1 adeno-ma.Serum AFP were all increased.The ultrasound presented solid mass .Rich blood flow reached 84.8% in CDFI.Scrotum X-ray present no exact calcification shadow.60 cases were treated by high positioned excision of testicle,1 case testis-sparing surgery,1 1 cases were combined with radical dissection of inguinal lymph nodes.Pathological features showed micro capsule and reticular structure、gland tube-gland bubble structure、papillary structure.PEB and PVB often offered after operation.AFP can meet the normal level in 1 -2 months and no replase、death. Conclusion Most children with yolk sac tumor presented with painless scrotal mass, increased AFP,bearing down and solid mass in ultrasound.The main treatment is high positioned excision of testicle.Frozen Section can help choosing the scope of the excision.Chemotherapy after the surgery makes a good prognosis.