小儿原发性睾丸肿瘤31例临床分析

Clinical Analysis of 31 Cases of Primary Testicular Tumors in Children

目的：总结小儿原发性睾丸肿瘤的临床特点和诊治经验。方法：对2005年1月-2015年3月本院收治的31例小儿原发性睾丸肿瘤的临床资料进行回顾性分析。患儿发病年龄2个月~10岁,多以阴囊内无痛性肿块就诊,1例以隐睾就诊,1例以阴囊外伤就诊。结果：病理显示卵黄囊瘤10例,畸胎瘤13例,表皮样囊肿3例,横纹肌肉瘤2例,精原细胞瘤1例,淋巴管瘤1例,血管瘤1例。获得随访26例,平均随访3年。随访病例中4例成熟畸胎瘤和1例淋巴管瘤行高位精索切断睾丸切除术;2例Ⅰ期未成熟畸胎瘤、2例Ⅰ期横纹肌肉瘤、9例I期卵黄囊瘤和1例Ⅱ期卵黄囊瘤均行高位精索切断睾丸切除术后辅以化疗;4例成熟畸胎瘤和3例表皮样囊肿行保留睾丸的肿瘤剜除术。26例随访患儿均无瘤存活至今。结论：早期诊断、早期手术是小儿原发性睾丸肿瘤获得良好疗效的关键。Ⅰ期卵黄囊瘤宜行高位精索切断睾丸切除术后辅以化疗,对良性睾丸肿瘤应根据术中快速冰冻病理切片决定睾丸的取舍。

Objective：To summarize the management of testicular tumors in children.Method：The clinical data of 31 children（age between 2 months to 10 years） with testicular tumors were retrospectively analyzed.Of them most children presented with painless scrotal mass,one with cryptorchidism,and one with scrotal trauma.Result：Of them 10 cases had yolk sac tumors,13 had teratomas,3 dermoid cysts,2 rhabdomyosarcomas,1 seminoma,1 lymphangioma,1 hemangioma.All cases were confirmed by pathology.Of the 31 cases 26 were followed up with a mean time of 3 years.In the follow-up cases,4 mature teratomas and 1 lymphangioma underwent high amputation of spermatic cord with orchiectomy.2 immature teratomas with stage Ⅰ,2 rhabdomyosarcomas with stage Ⅰ,9 yolk sac tumors with stage Ⅰ and 1 yolk sac tumor with stage Ⅱ were treated with a combination regimen of surgery and chemotherapy.4 mature teratomas and 3 dermoid cysts were treated with Testicular-sparing enucleation.Conclusion：Early diagnosis and early operation is the key to the treatment of children primary testicular tumors.Children with testicular yolk sac tumors in stage Ⅰ can be managed by combination regimen of surgery and chemotherapy.Organ-sparing enucleation surgery can be used in some benign testicular tumors,according to intraoperative frozen pathology.