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目的:分析儿童睾丸畸胎瘤的诊断与治疗,旨在提高其临床诊治水平。方法:回顾性分析本院1995~2014年收治的64例儿童睾丸畸胎瘤的临床资料。结果:61例以无痛性阴囊包块就诊,查体均有沉重感;3例因阴囊空虚诊断为隐睾时发现。术前46例甲胎蛋白(AFP)明显升高,18例AFP值正常。超声检查提示异常混杂回声区,内有钙化成分或液化坏死。阴囊X片检查28例有点片状、弧形高密度影。40例于我院行睾丸肿瘤剜除术(TSS),1例院外手术,20例行高位瘤睾切除术,3例放弃手术治疗。病理检查成熟畸胎瘤均可见成熟的3个胚层,未成熟畸胎瘤可见原始神经管等未成熟胚层成分。60例手术患儿中11例为不成熟畸胎瘤,49例成熟畸胎瘤。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后采用顺铂+依托泊苷+博来霉素(Cisplatin,Etoposide,Bleomycin,PEB)方案化疗。随访2年均未见复发或转移。结论:儿童睾丸畸胎瘤多因无痛性阴囊包块就诊,查体包块有沉重感;AFP多有异常,超声及阴囊平片对诊断有一定帮助。手术方案主要为TSS,术中冰冻能协助术者选择手术范围。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后应配合化疗。
Objective: To analyze the diagnosis and treatment of children’s testicular teratoma in order to improve its clinical diagnosis and treatment. Methods: The clinical data of 64 children with testicular teratoma admitted from 1995 to 2014 in our hospital were analyzed retrospectively. Results: 61 cases with painless scrotal mass examination, physical examination were heavy; 3 cases were diagnosed as cryptorchidism due to empty scrotum was found. 46 cases of preoperative AFP (AFP) was significantly elevated, 18 cases of AFP values were normal. Ultrasound examination showed abnormal mixed echo, calcification or liquefaction necrosis. Scrotal X-ray examination of 28 cases a bit flaky, arc-shaped high-density shadow. Forty patients underwent testicular tumor resection (TSS) in our hospital, one patient underwent extrahepatic surgery, 20 patients with high tumor excision and three patients who gave up surgery. Pathological examination of mature teratomas are visible in three mature germ layers, immature teratoma visible primitive neural tube and other immature germ layer components. Eleven patients in 60 surgeries were immature teratomas and 49 mature teratomas. Mature teratoma without chemotherapy after surgery, immature teratoma with cisplatin + etoposide + bleomycin (Ctopicide, Etoposide, Bleomycin, PEB) regimen chemotherapy. No recurrence or metastasis was observed in 2 years follow-up. Conclusion: Most children with testicular teratoma are often treated with painless scrotal mass. Massive abnormality is found in the examination mass. AFP is often abnormal. Ultrasound and scrotal radiographs are helpful for the diagnosis. Surgical options mainly TSS, intraoperative freezing can help surgeons choose the scope of surgery. Mature teratoma without chemotherapy, immature teratoma should be combined with chemotherapy.