小儿睾丸良性肿瘤的诊治方法及预后分析

The diagnosis,treatment and prognosis of pediatric with benign testicular tumors

目的：探讨小儿睾丸良性肿瘤的诊断、治疗方法及预后。方法回顾性分析2008年1月至2015年12月收治的26例睾丸良性肿瘤患儿的临床资料。年龄17 d～12岁，平均2．5岁。肿瘤位于左侧17例，右侧9例。其中20例以睾丸肿块就诊，3例以隐睾就诊，2例以鞘膜积液就诊，1例以精索静脉曲张就诊。26例行超声或CT检查，20例提示睾丸占位，3例提示阴囊空虚，3例提示阴囊内肿物。24例行肿瘤标志物检查，其中4例甲胎蛋白增高，2例神经元特异性烯醇化酶轻度升高，1例铁蛋白升高。26例均行手术治疗，根据术中所见及快速冷冻病理检查结果，23例行保留睾丸的肿瘤切除术，3例因睾丸形态结构异常行睾丸切除术。结果术后病理诊断为成熟性畸胎瘤14例，不成熟性畸胎瘤3例，性腺母细胞瘤3例，间质细胞瘤2例，表皮样囊肿2例，纤维瘤、睾丸炎性肉芽肿各1例。23例患儿获得随访，随访时间3～70个月，所有受访患儿均存活，未见残留睾丸萎缩或肿瘤复发、转移等情况。结论早期诊断及治疗是睾丸肿瘤获得良好疗效的关键。详细的专科查体，术前超声、CT及肿瘤标志物是诊断睾丸肿瘤的重要方式；术中快速冷冻病理检查可明确肿瘤性质。对于小儿睾丸良性肿瘤可采取保留睾丸的肿瘤切除术。

Objective To explore the diagnosis, treatment and prognosis of testicular benign tumors in children.Methods The clinical data of 26 boys （ aged between 17 days to 12 years and average age was 2.5 years） with testicular benign tumors treated in our center between January 2008 and December 2015 were retrospectively analyzed.The tumors were on the left side in 17 cases, on the right side in 9 cases. Twenty patients presented with painless scrotal mass.3 with cryptorchidism, 2 cases with hydrocele, and 1 case with varicocele.These boys underwent ultrasound or CT examination, results the enlarged tests with space-occupying lesions in 20 cases,3 cases were presented as scrotal empty,3 cases were showed as cystic masses.Twenty-four boys had taken tumor marker detection,which including 3 cases of AFP rised, 2 cases of Neuron-specific enolase slightly higher, 1 case of Ferritin increased.26 patients were performed surgical treatment, 23 cases have taken testicular tumor resection, and 3 cases underwent orchiectomy because of abnormal morphology, according to the intraoperative findings and quick frozen pathological examination results.Results Postoperative pathological diagnosis showed of maturity teratoma in 14 cases, not maturity teratoma in 3 cases, gonadoblastoma in 3 cases, interstitial cell tumor in 2 cases, epidermoid cyst in 2 cases, fibrocellular tumor and testicular inflammatory granuloma in 1 case respectively.The 23 cases were followed up for 3-70 months.All respondents children were alive, and no complications were found such as residual tumor atrophy or tumor recurrence and metastasis.Conclusions Early diagnosis and treatment is the key to obtaining a good effect of testicular tumors. Detailed specialist examination, preoperative ultrasound, CT and determination of tumor markers are important ways to diagnose testicular cancer; rapid intraoperative frozen check may manifest nature of the tumors.For pediatric testicular benign tumor, testis-sparing surgery should be considered.