Is期睾丸混合性生殖细胞瘤不同治疗方法研究(附3例报告)
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摘要
目的:本文旨在探讨Is期睾丸混合性生殖细胞瘤的不同治疗方法。方法:对2008年2月至2012年6月收治3例(年龄26~39岁)入院的Is期睾丸混合性生殖细胞瘤患者的临床资料进行回顾性分析和总结,并结合文献就该期肿瘤的临床特征进行探讨。结果:3例患者中1例只行根治性睾丸切除术,1例行根治性睾丸切除术+腹膜后淋巴结清扫术+BEP方案化疗,1例行根治性睾丸切除术+放疗。混合性生殖细胞瘤病理成分分别为左侧95%未成熟畸胎瘤、精原细胞瘤合并5%绒癌、胚胎性癌成分,左侧75%精原细胞瘤合并25%胚胎性癌、畸胎瘤成分,右侧90%成熟性畸胎瘤合并10%卵黄囊瘤。随访24个月3例患者肿瘤无局部复发和远处转移。结论:对于Is期睾丸混合性生殖细胞瘤诊断主要依靠体格检查、超声、MRI、血清肿瘤标记物测定等,确诊需要病理学检查,根治性睾丸切除术是其基础的治疗方法。
Objective: To investigate different treatment methods for stage-Is testicular mixed germ cell tumors( TMGCTs).Methods: We retrospectively analyzed the clinical data about 3 cases of stage-Is TMGCTs( aged 26- 39 years) treated in the 175 th Hospital of PLA,reviewed relevant literature,and explored the clinical characteristics of TMGCTs. Results: Of the 3 patients,1 was treated by radical orchiectomy,1 by radical orchiectomy + retroperitoneal lymph node dissection + BEP chemotherapy scheme,and the other by radical orchiectomy + radiotherapy. The pathological components of TMGCTs were immature teratoma,seminoma,spermatocytoma,chorioepithelioma,embryonal carcinoma,and yolk sac tumor. No recurrence or distant metastasis was found during the24-month follow-up after surgery. Conclusion: The diagnosis of TMGCTs primarily depends on physical examination,ultrasonography,MRI,and measurement of serum tumor markers,while its confirmation necessitates pathological examination,and its treatment is basically radical orchiectomy.
Objective: To investigate different treatment methods for stage-Is testicular mixed germ cell tumors( TMGCTs).Methods: We retrospectively analyzed the clinical data about 3 cases of stage-Is TMGCTs( aged 26- 39 years) treated in the 175 th Hospital of PLA,reviewed relevant literature,and explored the clinical characteristics of TMGCTs. Results: Of the 3 patients,1 was treated by radical orchiectomy,1 by radical orchiectomy + retroperitoneal lymph node dissection + BEP chemotherapy scheme,and the other by radical orchiectomy + radiotherapy. The pathological components of TMGCTs were immature teratoma,seminoma,spermatocytoma,chorioepithelioma,embryonal carcinoma,and yolk sac tumor. No recurrence or distant metastasis was found during the24-month follow-up after surgery. Conclusion: The diagnosis of TMGCTs primarily depends on physical examination,ultrasonography,MRI,and measurement of serum tumor markers,while its confirmation necessitates pathological examination,and its treatment is basically radical orchiectomy.
引文
[1]那彦群,叶章群,孙颖浩,等主编.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2014.91-92.
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[6]鄢丽敏,宋文静.睾丸恶性混合性生殖细胞肿瘤1例.天津医药,2010,38(4):349-350.
[7]胡礼炳,雷永虹,HOHENFELLNER M.2012年欧洲泌尿外科学会睾丸肿瘤诊疗指南解读.昆明医科大学学报,2012,33(7):79-83
[8]王金万,杨林,王佳玉,等.睾丸生殖细胞肿瘤综合治疗的长期疗效.中华肿瘤杂志,2003,25(4):382-385.
[9]Martin JM,Panz arella T,Zwahlen DR,et al.Evidence-based guidelines for following stage 1 seminoma.J Cancer,2007,109(11):2248-2256.
[10]张圣熙,宋旭,林文耀,等.I期睾丸混合性生殖细胞瘤的诊断与治疗(附2例报告).中华男科学杂志,2013,19(7):667-671.
[11]张东旭,崔心刚,李勋钢,等.腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告.临床泌尿外科杂志,2012,27(2):503-505.
[12]张朋,曾浩,卢一平,等.睾丸生殖细胞肿瘤176例临床诊治分析.中华男科学杂志,2006,12(3):237-239.
[13]杨山,汪超军.睾丸生殖细胞肿瘤患者行睾丸部分切除术的1、3、5年生存率分析.中国性科学杂志,2014,23(4):52-54.
[14]关晓峰,邓耀良,刘启明,等.函数法分析AFP和β-h CG在睾丸肿瘤中的变化.中华男科学杂志,2013,19(1):59-62.
[15]关晓峰,刘启明,周德雄,等.睾丸混合性生殖细胞肿瘤1例.中华男科学杂志,2010,16(9):853-855.
[2]吴阶平主编.泌尿外科学.济南:山东科学技术出版社,2000.997.
[3]李路,李家贵.原发性睾丸肿瘤研究新进展.现代泌尿生殖肿瘤杂志,2009,1(6):321-324.
[4]Sternberg SS主编.诊断外科病理学.第3版.北京:北京大学医学出版社,2003.1973-2033.
[5]陈志刚,尚东浩,陈永骞,等.睾丸混合性生殖细胞肿瘤1例.临床泌尿外科杂,2012,27(2):159-160.
[6]鄢丽敏,宋文静.睾丸恶性混合性生殖细胞肿瘤1例.天津医药,2010,38(4):349-350.
[7]胡礼炳,雷永虹,HOHENFELLNER M.2012年欧洲泌尿外科学会睾丸肿瘤诊疗指南解读.昆明医科大学学报,2012,33(7):79-83
[8]王金万,杨林,王佳玉,等.睾丸生殖细胞肿瘤综合治疗的长期疗效.中华肿瘤杂志,2003,25(4):382-385.
[9]Martin JM,Panz arella T,Zwahlen DR,et al.Evidence-based guidelines for following stage 1 seminoma.J Cancer,2007,109(11):2248-2256.
[10]张圣熙,宋旭,林文耀,等.I期睾丸混合性生殖细胞瘤的诊断与治疗(附2例报告).中华男科学杂志,2013,19(7):667-671.
[11]张东旭,崔心刚,李勋钢,等.腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告.临床泌尿外科杂志,2012,27(2):503-505.
[12]张朋,曾浩,卢一平,等.睾丸生殖细胞肿瘤176例临床诊治分析.中华男科学杂志,2006,12(3):237-239.
[13]杨山,汪超军.睾丸生殖细胞肿瘤患者行睾丸部分切除术的1、3、5年生存率分析.中国性科学杂志,2014,23(4):52-54.
[14]关晓峰,邓耀良,刘启明,等.函数法分析AFP和β-h CG在睾丸肿瘤中的变化.中华男科学杂志,2013,19(1):59-62.
[15]关晓峰,刘启明,周德雄,等.睾丸混合性生殖细胞肿瘤1例.中华男科学杂志,2010,16(9):853-855.