保留睾丸单位的睾丸肿瘤显微切除术

Experience of testicular sparing microsurgery for testicular tumor

目的:探讨睾丸肿瘤的保留睾丸单位显微切除手术的临床价值。方法:5例患者,年龄13-32周岁,体检:外生殖器发育与同龄人相仿,睾丸大小质地可,血清性激素检测均正常范围,血清睾丸肿瘤标志物检测指标均正常范围。超声检查:睾丸内实质性肿块0.125-2.925cm3。手术探查,打开睾丸鞘膜,睾丸白膜表面触诊无法触及肿块,遂在×10显微镜下,在睾丸白膜正中垂直纵径行2/3周径的切口,避开明显动脉和静脉,完全铺开伸展睾丸内实质,以术前超声提示部位探查睾丸内部,找到的异常组织,完全切除送术中冰冻病理检查,4-0 Prolene线连续关闭白膜和可吸收线分层关闭阴囊切口。结果:1例术中冰冻病理提示"小细胞恶性肿瘤",即于患侧睾丸根治性切除。术后石蜡切片(酶标)病理:精原细胞瘤,术后2周转肿瘤科综合治疗。4例术中冰冻提示"良性病变",术后石蜡切片(酶标)病理:睾丸组织钙化、leyding细胞瘤、睾丸皮样囊肿、睾丸上皮内瘤样变。患者定期门诊超声随访,患侧睾丸恢复性生长,其中2例随访1年以上,两侧睾丸体积接近。结论:显微手术可以保护健康组织的同时完整探查整个睾丸内部实质,切除仅可由超声发现的微小病变,再结合术中病理检查,可以作为保留睾丸单位的睾丸肿瘤首选手术。

Objective：To evaluate the therapeutic effect of testicular sparing microsurgery for testicular tumor.Methods：Five patients who underwent testicular sparing microsurgery from September 2005 to December 2012 in our hospital were reviewed.Their age ranged from 13 to 32 years,3 cases were in left side,2 cases were in right side.Preoperative AFP was normal in all cases.The mircosurgery was via an × 10 microscope,an incision was made in the tunica albuginea and the mass was enucleated finely.We follow-up for 2 months to 36 months.Results：The mass was the common presentation in 3 cases on left side,2 cases on right side.One case was diagnosised as seminoma and underwented radical orchiectomy.The other pathological diagnosis included testicular calcification,leyding cell tumor,testicular dermoid cyst and testicular intraepithelial neoplasia,which were successfully performanced testicular sparing microsurgery.All patients were followed-up,postoperative ultrasonic data indicated that the volume of the involved testes showed no significance compared to preoperative ultrasonic data.Conclusion：Testicular paring microsurgery and frozen section examination should be the first choice to the treatment of micro tumor by the preoperative ultrasound.