CAJ | 학술논문

目的探讨小儿睾丸卵黄囊瘤的诊治方法.方法本组12例,年龄2个月～8岁.多以无痛性阴囊肿块就诊.术前常规进行血清AFP检查,胸片和(或)胸部CT检查,阴囊和腹膜后超声检查,睾丸MRI检查.术中冷冻病检了解肿瘤性质,决定手术方式.采用高位精索离断式睾丸切除,术后根据瘤体性质进行相应的化疗,必要时行腹膜后淋巴结清扫术.术后随访3个月～2年,监测血清AFP动态变化,并行阴囊、腹股沟、腹膜后超声检查和胸片检查.结果本组12例,病理结果均为卵黄囊瘤.高位精索离断式睾丸切除11例,睾丸肿瘤剔除术1例.卵黄囊瘤Ⅰ期12例,10例术后化疗一个疗程,睾丸肿瘤剔除术1例术后拒绝化疗,1例因为经济困难未行化疗,术后6个月肝肺腹盆腔、骨骼转移、后腹膜淋巴结广泛转移压迫下腔静脉致布加氏综合征,放弃治疗；1例术后1个月复检AFP再次阳性,PET检查提示阴囊残留复发(再次手术),腹膜后转移1例,并行腹膜后淋巴结清扫.12例获随访,平均随访16个月.结论卵黄囊瘤Ⅰ期宜行高位精索离断式睾丸切除术,Ⅱ期以上应考虑行腹膜后淋巴结清扫,术后宜配合化疗.
목적 탐토소인고환란황낭류적진치방법.방법 본조12례,년령2개월～8세.다이무통성음낭종괴취진.술전상규진행혈청AFP검사,흉편화(혹)흉부CT검사,음낭화복막후초성검사,고환MRI검사.술중냉동병검료해종류성질,결정수술방식.채용고위정색리단식고환절제,술후근거류체성질진행상응적화료,필요시행복막후림파결청소술.술후수방3개월～2년,감측혈청AFP동태변화,병행음낭、복고구、복막후초성검사화흉편검사.결과 본조12례,병리결과균위란황낭류.고위정색리단식고환절제11례,고환종류척제술1례.란황낭류Ⅰ기12례,10례술후화료일개료정,고환종류척제술1례술후거절화료,1례인위경제곤난미행화료,술후6개월간폐복분강、골격전이、후복막림파결엄범전이압박하강정맥치포가씨종합정,방기치료；1례술후1개월복검AFP재차양성,PET검사제시음낭잔류복발(재차수술),복막후전이1례,병행복막후림파결청소.12례획수방,평균수방16개월.결론 란황낭류Ⅰ기의행고위정색리단식고환절제술,Ⅱ기이상응고필행복막후림파결청소,술후의배합화료.
Objectives To explore the diagnosis and treatment of testicular yolk sac tumors in children.Methods The clinical data of 12 cases (aged between 2 months to 8 years) with testicular yolk sac tumors was retrospectively analyzed.Most of children presented with painless scrotal mass.All cases accepted the serum alpha-fetoprotein (AFP) measurement,chest slice and(or) chest CT scan,testicle Magnetic Resonance Imaging (MRI)check,testicular and retroperitoneal ultrasonography.In order to determine procedures of surgical operation,testicular rumors were frozen sectioned to perform pathological examination during operation.Chemotherapy was performed according to the character of tumour after operation.Most patients underwent orchiectomy,while retroperitoneal lymph node resection was performed in certain circumstance.All cases were followed up for about 3 months to 2years postoperatively,with surveillance of AFP,testicular and retroperitoneal ultrasonography,and chest X-ray.Results Pathology the result is all YST Of the 12 cases,11 cases underwent high ligation and spermatic testicular resection,and1 case underwent testicular sparing enucleation surgery,and 12 cases were followed up,mean time 16 months,and 10 cases (stage Ⅰ) accepted one course of chemotherapy,1 case refuses a chemotherapy after testicular sparing enucleation surgery,1 case because the financial straits didnt go a chemotherapy,postoperatively 6 month the liver lung abdomen pelvic cavity,skeleton metastasis,retroperitoneal lymph the knot extensively metastasis to oppress inferior vena cava result to inferior vena cava obstruction syndrome,give up a treatment;1 cases under-went reoperation and re-chemotherapy because of AFP reoccurrence,PET check hint the scrotum remain to relapse(again surgical operation) tumors recrudescence,and 1 case retroperitoneal metastasis.Conclusions Children with tesitcular yolk sac tumors in stage Ⅰ can be managed with high ligation and spermatic testicular resection,and those in stage Ⅱ-Ⅳcan be done with high ligation and spermatic testicular resection,and retroperitoneal lymph nodes resection,and chemotherapy.