小儿左侧腹腔内隐睾畸胎瘤1例并文献复习

Mature teratoma arising from an intra-abdominal testis in a child:one case report with a literature review

目的探讨小儿腹腔内隐睾合并睾丸肿瘤的诊治方法。方法回顾性分析2018年10月福建医科大学附属泉州第一医院小儿外科收治的1例1岁5个月腹腔内隐睾畸胎瘤男性患儿的临床资料,患儿经腹腔镜探查发现左侧腹腔内隐睾畸胎瘤并左侧隐睾扭转、坏死,予以行左侧隐睾及肿瘤完整切除。同时检索万方数据库、中国知网、维普数据库、中国生物医学文献服务系统、PubMed、Google Scholar数据库,中文检索关键词为"不可触及隐睾"和"睾丸肿瘤",英文检索关键词为"non-palpable testes"和"testicular tumor",文献发表时间为1984年6月至2020年6月,对检索到的文献资料行文献复习。结果本例患儿手术顺利,术后恢复良好出院,术后病理提示囊实性成熟性畸胎瘤,术后随访20个月无复发。文献检索到相关文献25篇共25例患儿,术前均行超声或者CT检查协助诊断,其中左侧隐睾14例,右侧隐睾11例,平均就诊年龄为22.6个月,肿瘤平均长径约为6.4 cm。25例均行手术治疗,其中3例行腹腔镜探查,1例行腹股沟切口,1例行腹股沟切口中转开腹,20例行开腹手术。术后病理提示成熟性畸胎瘤20例、未成熟性畸胎瘤2例、卵黄囊瘤2例(1例Ⅰ期、1例Ⅲ期)、胚胎性癌联合卵黄囊瘤1例。2例卵黄囊瘤术后均予以化疗。13例患儿得到随访,无1例复发。结论对于不可触及隐睾患儿,应常规行腹部超声或腹部CT以排除可能存在的腹腔内睾丸肿瘤。正常下降睾丸引起肿瘤以卵黄囊瘤多见,而腹腔内睾丸肿瘤以畸胎瘤多见,且多数为成熟性畸胎瘤。发现后及时手术治疗,术后病理提示恶性肿瘤的,须辅以化疗,总体上预后良好。

Objective To explore the diagnosis and treatment of intra-abdominal testicular tumors in children.Methods Clinical data were retrospectively reviewed for one 17-month-old boy of mature teratoma arising from an intra-abdominal testis in October 2018.An intra-abdominal testicular tumor and a left torsioned and necrotic testis were detected by laparoscopic exploration.Tumor and the testis were completely resected.And the relevant literature reports were retrieved from the databases of WanFang,CNKI,Weipu,CBM,PubMed and Google Scholar from June 1984 to June 2020.The keywords were non-palpable testes and testicular tumor.Results The operation was successful with a smooth postoperative recovery.Postoperative pathology revealed cystic and solid mature teratomas.There was no recurrence during a follow-up period of 20 months.A total of 25 eligible children were enrolled,including left cryptorchidism(n=14)and right cryptorchidism(n=11).The average age was 22.6 months and the average length of tumor approximately 6.4 cm.Ultrasound or computed tomography(CT)assisted in the preoperative diagnosis.The procedures included laparoscopy(n=3),inguinal incision(n=1),conversion of groin incision into laparotomy(n=1)and laparotomy(n=20).Postoperative pathological examinations revealed mature teratoma(n=20),immature teratoma(n=2),yolk sac tumor(n=2,stageⅠ/Ⅲeach)and embryonic carcinoma plus yolk sac tumor(n=1).Two cases of yolk sac tumor received chemotherapy.And 13 cases were followed up.There was no recurrence.Conclusions For children with non-palpable testes,abdominal Doppler ultrasound or CT should be routinely performed for ruling out possible intra-abdominal testicular tumors.Tumors derived from normally descended testes are mostly yolk sac tumors while those arising from intra-abdominal testes belong to teratomas.And most cases are mature teratomas.The prognosis is decent after an early diagnosis and timely surgery.As for a malignant tumor,it must be supplemented with chemotherapy and other comprehensive treatments and the overall prognosis is generally all right.