不同年龄段儿童睾丸肿瘤的超声诊断和临床分析

Clinical and ultrasonographic features of testis tumor in children of different ages

目的:探讨不同年龄段儿童睾丸肿瘤的超声声像图特征,并结合临床及手术病理资料进行分析。方法:回顾性分析2013年4月至2018年3月76例儿童睾丸肿瘤的临床资料、超声检查资料、手术方式及病理结果,依据初诊年龄分为0～4岁组(n=57)和5～12岁组(n=19),比较两组临床表现、肿瘤标志物、超声特征(肿瘤大小、回声性质、钙化、彩色血流情况)、病理结果(良恶性)和手术方式。结果:76例中73. 7%(56/76)的儿童睾丸肿瘤为良性肿瘤,其中5～12岁组睾丸肿瘤均为良性肿瘤[100%(19/19)],以表皮样囊肿最常见[52. 6%(10/19)],临床以体检偶然发现居多[47. 4%(9/19)],甲胎蛋白(AFP)值多不升高[94. 7%(18/19)],94. 4%(9/19)采用保留睾丸手术(TSS); 0～4岁组睾丸肿瘤以畸胎瘤和卵黄囊瘤最常见,临床以无痛性阴囊肿大居多[87. 7%(50/57)],AFP值可正常或升高,采用TSS或根治性睾丸切除术(RO),两组在临床表现、AFP值、病理结果和手术方式上差异均有统计学意义(P <0. 05)。超声检查儿童睾丸肿瘤以囊实混合性肿块和实性肿块多见,两组差异无统计学意义(χ~2=0. 908,P=0. 635); 5～12岁组肿瘤最大直径小于0～4岁组,健侧睾丸体积大于0～4岁组,差异均有统计学意义(t=2. 673,2. 858; P=0. 009,0. 010); 5～12岁组睾丸肿瘤伴钙化和彩色血流0级的比例多于0～4岁组,两组差异均有统计学意义(χ~2=4. 825,12. 298; P=0. 028,0. 006)。结论:不同年龄段儿童睾丸肿瘤有不同的临床和超声特点。恶性肿瘤多见于0～4岁儿童,5～12岁儿童以AFP值正常,多伴钙化,彩色血流不丰富的良性肿瘤多见,当超声诊断5～12岁儿童睾丸肿瘤且血清AFP值阴性时应提倡TSS以尽量保留睾丸功能。

Objective： To explore the ultrasonographic characteristics of testis tumor in children of different ages. Methods：We retrospectively analyzed the clinical data,ultrasonographic results,surgical methods and pathological findings of 76 children with testis tumor treated in Shanghai Children＇s Hospital between April 2013 and March 2018. According to the age at the first diagnosis,we divided the patients into a 0-4 yr（ n = 57） and a 5-12 yr group（ n = 19）,and compared the clinical manifestations,tumor markers,ultrasonographic features such as the tumor size,echogenicity,calcification and color flow images,pathological findings,and surgical methods between the two groups of patients. Results： Benign tumors were found in 73. 4% of the 76 children and in 100% of the patients in the 5-12 yr group,with epidermoid cyst as the most common type（ 52. 6% [10/19]）,47. 4%（ 9/19） found accidentally,94. 7%（ 9/19） without elevation of the alpha-fetoprotein（ AFP） level,and 94. 7%（ 9/19） treated by testis-sparing surgery（ TSS）. In the 0-4 yr group,teratoma and yolk sac tumors were the most common and 87. 7%（ 50/57） of the cases were characterized by painless scrotal swelling with a normal or elevated AFP level,treated by TSS or radical orchiectomy. There were statistically significant differences between the two groups of patients in the clinical manifestations,AFP values,pathological findings and surgical methods（ all P〈0. 05）,but not in the ultrasonographic results,mostly solid or mixed cystic-solid masses（ χ^2= 0. 908,P =0. 635）. The maximum diameter of the tumors was smaller and the volume of the healthy contralateral testis was greater in the 5-12 yr than in the 0-4 yr group（ t = 2. 673 and 2. 858,P = 0. 009 and 0. 010）. The proportions of the tumors with calcification and those with grade 0 blood flow were significantly higher in the former than in the latter group（ χ~2= 4. 825 and 12. 298,P = 0. 028 and0. 006）. Conclusion： Testis tumors have different clinical and ultrasonographic features in children of different age groups,malignancy mostly in 0-to 4-year-olds while benignancy commonly in 5-to 12-year-olds,frequently with normal AFP,calcification,and less abundant color blood flow. TSS is recommended for the treatment of testis tumor with serum AFP negative in 5-12 years old children.