腹腔镜下根治性睾丸切除术治疗青年睾丸肿瘤临床疗效分析

Clinical Analysis of Laparoscopic Radical Orchiectomy in the Treatment of Testicular Tumors

【目的】探讨腹腔铣下根治性睾丸切除术治疗青年睾丸肿瘤的可行性和疗效。【方法】回顾性分析2019年10月至2020年9月本院收治的7例睾丸肿瘤患者,所有患者均在全麻下成功接受腹腔镜下根治性睾丸切除术。手术采用三孔法,内环口上方弧形切开腹膜,游离输精管及精索,分别结扎,阴囊上方沿皮纹切口,游离并牵拉出精索,切除睾丸,缝合腹膜切口。记录患者手术时间、住院时间、并发症发生情况,比较手术前后睾丸肿瘤标志物水平,包括甲胎蛋白(AFP)、人绒毛膜促性腺激素(HCG)、乳酸脱氢酶(LDH)。【结果】7例青年患者平均手术时间(103.9±25.8)min,平均住院天数(6.6±1.9)d,术中出血量(12.1±5.7)ml。术后并发症依据Clavien-Dindo评价,其中Ⅰ级2例,包括1例患者术中出现皮下气肿,术后第2天自行消退,1例患者出现术后伤口疼痛,需要止痛药物治疗,未见Ⅱ〜Ⅴ级并发症。术后未见伤口感染、尿路感染、腹痛、腹股沟疝、肠梗阻等并发症的发生。平均随访(6.1土4.7)个月,未见局部肿瘤复发和远处转移。手术前后HCG、AFP、LDH水平比较,差异无统计学意义(P>0.05)。【结论】腹腔铣根治性睾丸切除术治疗睾丸肿瘤技术是可行的,并且安全有效。

[Objectivc]To assess the feasibility and outcomes of laparoscopic radical orchiectomy in the management of testicular tumor.【Methods】From October 2019 to September 2020,7 patients with testicular tumor in our hospital were retrospectively analyzed.All patients successfully underwent laparoscopic radical orchiectomy under general anesthesia.The peritoneum was incised above the inner ring,the vas deferens and spermatic cord were ligated respectively,the spermatic cord was pulled out and the testis was removed,and the peritoneum incision was sutured.The operation time,hospital stay and complications were recorded.The levels of tumor markers including alpha fetoprotein(AFP),human chorionic gonadotropin(HCG)and lactate dehydrogenase(LDH)were compared before and after operation.【Results】The average operation time of 7 young patients was(103.9±25.8)min,and the average length of stay was(6.6±1.9)d,intraoperative blood loss was(12.1±5.7)mL.According to Clavien Dindo evaluation,there were 2 cases of grade Ⅰ postoperative complications,including 1 case of subcutaneous emphysema during operation,which subsided spontaneously on the second day after operation,1 case of postoperative wound pain,which needed analgesic treatment,and no grade Ⅱ-Ⅴ complications were found.There were no postoperative complications such as wound infection,urinary tract infection,abdominal pain,inguinal hernia and intestinal obstruction.The average follow-up time was(6.1±4.7)months,no local tumor recurrence and distant metastasis.There was significant difference in HCG level before and after operation(P〈0.05),but no significant difference in AFP and LDH level(P〉0.05).【Conclusion】Laparoscopic radical orchiectomy is technically feasible,safe,and effective.