He Min,Cai Jiabin,Mao Junqin,et al.Surgical treatment for stage Ⅰ testicular malignant germ cell tumors via scrotal incision[J].Journal of Clinical Pediatric Surgery,2022,21(07):643-647.[doi:10.3760/cma.j.cn101785-202008007-009]
经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤
- Title:
- Surgical treatment for stage Ⅰ testicular malignant germ cell tumors via scrotal incision
- Keywords:
- Germinoma; Testicular Neoplasms; Scrotum/SU; Groin/SU
- 摘要:
- 目的 探讨经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤的可行性和安全性。方法 收集浙江大学医学院附属儿童医院2014年1月至2019年12月收治的41例Ⅰ期睾丸恶性生殖细胞肿瘤患儿作为研究对象，按手术入路不同分为阴囊切口组（14例）和腹股沟切口组（27例）。收集两组患儿一般资料、手术时间、术后住院时间及术后并发症情况，并进行比较分析。结果 41例均顺利完成手术。两组患儿年龄、体重、肿瘤直径、病理类型比较，差异无统计学意义（P>0.05）。阴囊切口组手术时间及术后住院时间分别为（39.3±9.2） min和（3.6±1.5） d，腹股沟切口组分别为（42.0±8.6） min和（4.3±2.2） d，两组之间差异均无统计学意义（P>0.05）。阴囊切口组患儿术前甲胎蛋白（alpha fetoprotein，AFP）值为（7 203.9±16 096.3） ng/mL，术后1个月为（21.2±14.0） ng/mL，术后2个月为（12.9±9.4） ng/mL。腹股沟切口组术前AFP值为（5 048.8±8 106.1） ng/mL，术后1个月为（32.2±41.3） ng/mL，术后2个月为（22.4±37.9） ng/mL。两组术后AFP较术前均明显降低，差异均有统计学意义（P<0.05）。两组各时间段AFP值比较差异均无统计学意义（P>0.05）。并发症方面，阴囊切口组有1例出现切口裂开，腹股沟切口组无一例围手术期并发症发生。两组术后随访时间分别为6~74个月和8~69个月，总体生存率均为100%；阴囊切口组和腹股沟切口组无病生存率分别为13/14和24/27，差异无统计学意义（P>0.05）。结论 经阴囊切口手术治疗儿童Ⅰ期睾丸恶性生殖细胞肿瘤可达到与传统腹股沟切口手术同样的临床疗效和预后，操作更简单，并发症可控，值得临床推广应用。
- Abstract:
- Objective To explore the safety and feasibility of surgery for stage Ⅰ testicular malignant germ cell tumors via scrotal incision.Methods From January 2014 to December 2019, clinical data were retrospectively reviewed for 41 children with testicular malignant germ cell tumor without inguinal or retroperitoneal lymph node enlargement.The median age was 36(4-96) months.According to operative approach, they were divided into scrotal and inguinal groups.Perioperative related parameters and postoperative complications were compared between two groups.Results Both groups completed operations smoothly.No significant inter-group differences existed in age, body weight, tumor diameter or pathological type (P>0.05).Operative duration and postoperative hospitalization time of scrotal group were (39.3±9.2) min and (3.6±1.5) d respectively and that of groin group was (42.0±8.6) min and (4.3±2.2) d and the inter-group difference was not statistically significant (P>0.05).In scrotal group, preoperative value of alpha fetoprotein (AFP) was (7 203.9±16 096.3) ng/mL, (21.2±14.0) ng/mL at Month 1 post-operation and (12.9±9.4) ng/mL at Month 2 post-operation.In inguinal group, AFP value was (5 048.8±8 106.1) ng/mL pre-operation, (32.2±41.3) ng/mL at Month 1 post-operation and (22.4±37.9) ng/mL at Month 2 post-operation.After operation, AFP in both groups was significantly lower than that pre-operation with statistical significance (P<0.05).No significant inter-group difference existed in AFP value (P>0.05).In terms of complications, one case of incision dehiscence occurred in scrotal group while no perioperative complication was observed in inguinal group.The postoperative follow-up period of two groups was (6-74)(8-69) months.The overall survival rate was 100% and the event-free survival rate 13/14 and 24/27 without statistical significance (P>0.05).Conclusion Surgery via scrotal incision for stage Ⅰ testicular malignant germ cell tumors can achieve the same efficacy and prognosis as traditional inguinal incision.The operation is simple and the complications are controllable.Wider popularization is worthwhile.
参考文献/References:
[1] Steliarova-Foucher E, Colombet M, Ries L, et al.International incidence of childhood cancer, 2001-10:a population-based registry study[J].Lancet Oncol, 2017, 18(6):719-731.DOI:10.1016/S1470-2045(17)30186-9.
[2] Maizlin II, Dellinger M, Gow KW, et al.Testicular tumors in prepubescent patients[J].J Pediatr Surg, 2018, 53(9):1748-1752.DOI:10.1016/j.jpedsurg.2017.09.020.
[3] 李曾, 廖洪, 毛顿, 等.单中心5年原发睾丸恶性肿瘤的临床诊治分析(附67例报告)[J].四川医学, 2018, 39(6):639-645.DOI:10.16252/j.cnki.issn1004-0501-2018.06.011.Li Z, Liao H, Mao D, et al.Analysis of 5-year single-center diagnosis and treatment of primary testicular malignant tumors:a report of 67 cases[J].Sichuan Medical Journal, 2018, 39(6):639-645.DOI:10.16252/j.cnki.issn1004-0501-2018.06.011.
[4] 姚强华, 汤静燕, 潘慈, 等.儿童Ⅰ期睾丸生殖细胞肿瘤41例临床诊治分析[J].中国实用儿科杂志, 2017, 32(11):842-845.DOI:10.19538/j.ek2017110610.Yao QH, Tang JY, Pan C, et al.Stage Ⅰ pediatric testicular germ cell tumors:An analysis of 41 cases[J].Chinese Journal of Practical Pediatrics, 2017, 32(11):842-845.DOI:10.19538/j.ek2017110610.
[5] Grantham EC, Caldwell BT, Cost NG.Current urologic care for testicular germ cell tumors in pediatric and adolescent patients[J].Urol Oncol, 2016, 34(2):65-75.DOI:10.1016/j.urolonc.2015.06.008.
[6] 胡慧勇, 陈亚青, 许云峰, 等.彩色多普勒超声对儿童睾丸良恶性肿瘤的鉴别诊断价值[J].中华超声影像学杂志, 2018, 27(3):226-231.DOI:10.3760/cma.j.issn.1004-4477.2018.03.011.Hu HY, Chen YQ, Xu YF, et al.The value of color Doppler ultrasonography in the differential diagnosis of benign and malignant testicular tumors in children[J].Chin J Ultra, 2018, 27(3):226-231.DOI:10.3760/cma.j.issn.1004-4477.2018.03.011.
[7] 程卫, 孙晓毅.小儿原发性睾丸肿瘤24例诊治体会[J].临床小儿外科杂志, 2008, 7(5):78.DOI:10.3969/j.issn.1671-6353.2008.05.029.Chen W, Sun XY.Diagnosis and treatment of 24 primary testicular tumors in children[J].J Clin Ped Sur, 2008, 7(5):78.DOI:10.3969/j.issn.1671-6353.2008.05.029.
[8] 韦科越, 王从军, 陈超.儿童原发性睾丸肿瘤47例诊治分析[J].现代肿瘤医学, 2017, 25(13):2079-2082.DOI:10.3969/j.issn.1672-4992.2017.13.017.Wei KY, Wang CJ, Chen C.Diagnosis and treatment of 47 children with primary testicular tumors[J].Journal of Modern Oncology, 2017, 25(13):2079-2082.DOI:10.3969/j.issn.1672-4992.2017.13.017.
[9] Moch H, Cubilla AL, Humphrey PA, et al.The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A:Renal, Penile, and Testicular Tumours[J].Eur Urol, 2016, 70(1):93-105.DOI:10.1016/j.eururo.2016.02.029.
[10] 张胜利, 张谦, 李泸平, 等.经阴囊切口手术治疗≤ 3岁儿童早期睾丸卵黄囊瘤的临床经验[J].中华泌尿外科杂志, 2018, 39(9):707.DOI:10.3760/cma.j.issn.1000-6702.2018.09.016.Zhang SL, Zhang Q, Li LP, et al.Clinical experience of transscrotal incision for early testicular yolk sac tumor in children aged under 3 years[J].Chinese Journal of Urology, 2018, 39(9):707.DOI:10.3760/cma.j.issn.1000-6702.2018.09.016.
[11] Schlatter M, Rescorla F, Giller R, et al.Excellent outcome in patients with stage I germ cell tumors of the testes:a study of the children’s cancer group/pediatric oncology group[J].J Pediatr Surg, 2003, 38(3):319-324.DOI:10.1053/jpsu.2003.50101.
[12] 中华医学会小儿外科学分会泌尿外科学组.中国儿童睾丸肿瘤诊疗专家共识[J].中华小儿外科杂志, 2021, 42(10):865-871.DOI:10.3760/cma.j.cn421158-20210427-00215.Group of Urological Surgery, Branch of Pediatric Surgery, Chinese Medical Association:Expert Consensus on Diagnosing & Treating Testicular Neoplasms in Prepubertal Males[J].Chinese Journal of Pediatric Surgery, 2021, 42(10):865-871.DOI:10.3760/cma.j.cn421158-20210427-00215.
[13] Cost NG, Lubahn JD, Adibi M, et al.A comparison of pediatric, adolescent, and adult testicular germ cell malignancy[J].Pediatr Blood Cancer, 2014, 61(3):446-451.DOI:10.1002/pbc.24773.
[14] 魏仪, 吴盛德, 林涛, 等.61例儿童睾丸卵黄囊瘤的诊断与治疗[J].临床小儿外科杂志, 2014, 13(4):267-270, 278.DOI:10.3969/j.issn.1671-6353.2014.04.002.Wei Y, Wu SD, Lin T, et al.Diagnosis and treatment of testicular yolk sac tumors in children:a report of 61 cases[J].J Clin Ped Sur, 2014, 13(4):267-270, 278.DOI:10.3969/j.issn.1671-6353.2014.04.002.
[15] Liu P, Li W, Song HC, et al.Characteristics, treatment decisions and outcomes of prepubertal testicular germ cell tumor:A descriptive analysis from a large Chinese center[J].J Pediatr Urol, 2018, 14(5):443.e1-e7.DOI:10.1016/j.jpurol.2018.02.030.
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备注/Memo
收稿日期:2020-08-03。
基金项目:浙江省自然科学基金（LQ20H160027）
通讯作者:王金湖,Email:wjh@zju.edu.cn