小儿睾丸肿瘤76例临床分析

Clinical analysis of testicular tumor in 76 children

目的总结小儿睾丸肿瘤的诊治经验。方法回顾性分析2003年1月至2013年12月于中国医科大学附属盛京医院小儿泌尿外科手术治疗的76例小儿睾丸肿瘤患者的病例资料，对其临床特征、病理诊断、治疗及预后进行归纳总结。结果76例患儿就诊时临床表现均为阴囊无痛性包块。就诊年龄1个月～13岁[（32．3±4．4）个月]，其中〈1岁39例（51．3％），1-3岁18例（23．7％），〉3-7岁10例（13．2％），〉7-14岁9例（11．8％）。左侧37例，右侧39例。病理结果：良性肿瘤59例（77．6％），其中畸胎瘤42例（55．2％，成熟型34例、未成熟型8例），表皮样囊肿11例，淋巴管瘤等其他肿瘤共6例；恶性肿瘤17例（22．4％），其中卵黄囊瘤16例（21．1％），均为Ⅰ期，睾丸胚胎癌1例。术前甲胎蛋白升高33例，包括9例成熟型畸胎瘤、7例未成熟畸胎瘤、16例卵黄囊瘤及1例睾丸胚胎癌。59例良性肿瘤中50例行肿物核除术，9例因肿物严重压迫睾丸实质而行睾丸切除术；17例恶性肿瘤均行根治性睾丸切除术。随访共76例，随访至今有1例卵黄囊瘤患儿因肺转移死亡，余均无瘤存活。结论睾丸肿瘤于1岁左右发病率最高，大多数为良性，畸胎瘤最常见。甲胎蛋白在卵黄囊瘤患儿中表达高，可用于协助诊断。对于良性肿瘤采取肿物核除术、对恶性肿瘤行根治性睾丸切除术治疗效果良好。

Objective To summarize the management and diagnosis of testicular tumors in children. Methods The clinical characteristics, diagnosis, treatment and outcome of patients with pediatric testicular tumors, who were referred to Department of Pediatric Surgery, Shengjing Hospital of China Medical University from January 2003 to December 2013, were analyzed retrospectively. Results All of the 76 prepubertal patients were diagnosed initially with a painless scrotal mass. The mean age of the patients at diagnosis ranged from 1 to 156 months [ mean（ 32.3 ± 4.4） months]. There were 39 cases（51.3% ） with ages of 0 - 1 years,18 cases （23.7%） with ages of 1 -3 years,10 cases （13.2%） with ages of 〉 3 -7 years,9 cases （11.8% ） with ages of 〉 7 -14 years. There were 37 cases in left side and 39 cases in right. And there were 59 cases （77.6%） of benign tumors and 17 cases （22.4%） of malignant tumors. Of the benign tumors,42 cases （55.2 % ）were teratomas, including 34 cases of mature teratoma and 8 cases of immature teratoma;11 cases were epidermoid cyst;11 cases were other benign tumors as lymphangioma. Among the 17 cases of malignant tumors, 16 cases （21.1% ）were yolk sac tumors,which were I stage;1 case was embryoma. Thirty -three patients had abnormal alpha fetoprotein （AFP）concentrations before surgery, including 9 patients with mature teratoma,7 patients with immature teratoma, 16 patients with yolk sac tumors, 1 patient with embryonal carcinoma of testis. Of the 59 cases of benign tumors, testis - sparing surgery was done in 50 tumors, the other 9 patients underwent testis-excising because of tumor severely oppressing testis. All the 17 cases of malignant tumors underwent testis - excising. There were 76 cases in the follow-up. One patient with yolk sac tumor died for pulmonary metastasis during the follow - up. Others were alive and free of tumor recurrence. Conclusions The age range of the prepubertal testicular onset was 1 year or younger, most of the tumors were benign, and the most common subtype was teratoma. AFP highly expressed in yolk sac tumors, it was help to diagnosis. Testis - sparing surgery should be performed for the benign tumors and testis - excising for the malignant tumors.