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目的总结临床诊断睾丸卵黄囊瘤Ⅰ期病例临床特征及治疗方法,探讨改进其诊治方案,提高预后。方法回顾性分析北京儿童医院泌尿外科2002年至2011年收治临床小儿睾丸卵黄囊瘤Ⅰ期25例患儿的临床资料,术后定期监测AFP、腹部超声及胸片等,随访其预后。结果临床表现均为患侧无痛性睾丸增大,质硬,AFP值增高,具体数值为135.68~15 874.00 ng/ml,超声(或CT)未见腹膜后及盆腔转移灶及淋巴结肿大,临床诊断均为Ⅰ期,给予精索高位离断瘤睾切除术,术后定期监测AFP、胸片、腹部超声(或CT)。入组睾丸卵黄囊瘤Ⅰ期25例患儿获随访17例,随访率为68%。17例随访患儿中16例健康存活,其中术后4周AFP降至正常者11例,术后6周AFP降至正常者3例,术后6周AFP降低后再次升高,化疗后健康存活者2例;另1例术后4周AFP仍明显高于正常,CT提示腹膜后转移,最终放弃治疗者。结论小儿睾丸卵黄囊瘤多因无痛性肿块就诊,肿块质硬,较对侧增大明显,较容易早期发现,结合AFP明显增高、胸片及腹部超声(或CT)等,临床分期多为Ⅰ期,手术方案为高位精索离断瘤睾切除术即可,无需腹膜后淋巴结清扫及常规化疗。术后需定期复查AFP、胸片、腹部超声等,对于术后4周AFP尚未降至正常且未及明显转移征象患儿可暂缓化疗,2周后再次复查AFP,对于术后6周AFP仍未降至正常的高危患儿需进行化疗。
Objective To summarize the clinical characteristics and treatment of stage Ⅰ clinical diagnosis of testicular yolk sac tumor, and to explore ways to improve its diagnosis and treatment and to improve the prognosis. Methods A retrospective analysis of clinical data of 25 children with clinical stage Ⅰ test of pediatric testicular yolk sac tumor from 2002 to 2011 in Beijing Children’s Hospital Urology was performed. AFP, abdominal ultrasonography and chest radiograph were monitored regularly after the operation. The prognosis was followed up. Results The clinical manifestations were all ipsilateral painless testicular enlargement, hard, AFP value increased, the specific value of 135.68 ~ 15 874.00 ng / ml, ultrasound (or CT) no retroperitoneal and pelvic metastases and lymph nodes, clinical The diagnosis was stage Ⅰ, given high sperm tumor resection esophagectomy, regular monitoring of AFP, chest X-ray, abdominal ultrasound (or CT). Twenty-five cases of stage Ⅰ testicular yolk sac tumor were followed up in 17 cases, the follow-up rate was 68%. Among the 17 children who were followed up, 16 cases survived. Among them, 11 cases whose AFP dropped to normal at 4 weeks after operation and 3 cases whose AFP dropped to normal at 6 weeks after operation were found. AFP decreased 6 weeks after operation and then increased again. Survival in 2 cases; the other 1 case 4 weeks after the AFP was still significantly higher than normal, CT prompt retroperitoneal metastasis, and ultimately give up the treatment. Conclusion Pediatric testicular yolk sac tumor was mostly treated with painless mass. The tumor mass was hard and obviously enlarged compared with the contralateral side. It was easier to detect early, combined with AFP, chest X-ray and abdominal ultrasonography (or CT) Stage Ⅰ, the surgical plan for high spermatic rupture resection excision can be, without retroperitoneal lymph node dissection and conventional chemotherapy. Postoperative AFP, chest X-ray, abdominal ultrasound, etc., for 4 weeks after the AFP has not been reduced to normal and no obvious signs of metastasis in children with suspend chemotherapy, AFP again after 2 weeks, 6 weeks after the AFP still The high-risk children who did not fall to normal need chemotherapy.