Comparative analysis of the efficacy between testicular sparing surgery and radical orchiectomy in the treatment of testicular leydig cell tumor
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摘要: 目的 探讨睾丸间质细胞瘤(leydig cell tumor，LCT)合适的手术方案，提高对该病的认识和诊疗水平。方法 回顾性分析2013—2023年郑州大学第一附属医院收治的30例LCT患者的临床资料，根据手术方式不同分为保留睾丸手术(testis-sparing surgery，TSS)组及睾丸根治性切除术(radical orchiectomy，RO)组，对2组临床资料进行比较分析。结果 30例患者中TSS组13例，RO组17例，2组患者肿瘤侧别、肿瘤位置、手术时间、末次随访生存时间等资料比较，差异无统计学意义(P>0.05)。而TSS组患者平均年龄为(24.54±11.52)岁，明显小于RO组的(38.65±15.93)岁(P < 0.05)；TSS组肿瘤平均直径为(1.66±0.72) cm，明显小于RO组的(2.53±1.35) cm(P < 0.05)。14例患者行术中快速冷冻切片检查，结果与常规病理一致，所有患者术后常规病理均显示LCT。TSS组随访(43.38±27.51)个月，RO组随访(59.41±31.54)个月，TSS组均为良性肿瘤，RO组有1例术后MRI显示盆腔及腹股沟多发淋巴结肿大，行4周期辅助化疗，术后8年末次随访未见肿瘤复发或新发转移，其余患者随访均无肿瘤复发。结论 手术是LCT最有效的治疗方式，术中应常规行快速冷冻切片检查，对于年轻者、肿瘤直径较小者，若考虑良性，优先选择保留睾丸手术。Abstract: Objective To explore the appropriate surgical scheme for testicular leydig cell tumor(LCT) and improve the understanding of diagnosis and treatment of the disease.Methods This study retrospectively analyzed the clinical data of 30 patients with testicular LCT treated in the First Affiliated Hospital of Zhengzhou University from 2013 to 2023. According to the different surgical methods, they were divided into testicular sparing surgery(TSS) group and radical orchiectomy(RO) group.Results Among the 30 patients, there were 13 cases in TSS group and 17 cases in RO group. There was no significant difference in tumor side, tumor location, operation time, survival time of the last follow-up between the two groups. The age of patients in TSS group was (24.54±11.52) years old, which was significantly less than that in RO group (38.65±15.93) years old. The tumor diameter in TSS group was (1.66±0.72) cm, which was significantly less than that in RO group (2.53±1.35) cm. Fourteen patients underwent intraoperative rapid frozen section examination, and the results were consistent with the conventional pathology. All patients' postoperative conventional pathology showed testicular LCT. The TSS group was followed up for (43.38±27.51) months, and the RO group was followed up for (59.41±31.54) months. All patients in the TSS group were benign tumors. One patient in the RO group had postoperative MRI showing multiple lymphadenopathies in the pelvic and inguinal regions, and received 4 cycles of adjuvant chemotherapy. No tumor recurrence or new metastasis was found in the follow-up at the end of 8 years after operation, and the rest patients had no tumor recurrence.Conclusion Surgery is the most effective treatment for LCT of testis. Rapid frozen section examination should be performed routinely during the operation. For young patients with smaller tumor diameters, if considering benign conditions, TSS is preferred.
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表 1 TSS组与RO组临床资料比较
例(%)，X±S 项目 TSS组(13例) RO组(17例) t/χ2 P值 年龄/岁 24.54±11.52 38.65±15.93 -0.294 0.012 肿瘤直径/cm 1.66±0.72 2.53±1.35 -2.076 0.047 侧别 0.452 1.000 左侧 6(46.2) 9(52.9) 右侧 6(46.2) 7(41.2) 双侧 1(7.6) 1(5.9) 肿瘤位置 0.276 1.000 上极 6(46.2) 7(41.2) 中部 4(30.8) 5(29.4) 下极 3(23.0) 5(29.4) 手术时间/min 90.85±36.71 78.35±41.59 0.088 0.385 末次随访生存时间/月 43.38±27.50 59.41±31.54 -1.456 0.157 
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