[睾丸癌及生殖-性疾病的腹膜后淋巴结清扫术：回顾性研究]

Castelli E, Terrone C, De Luca S, Rossetti S R

Clinique Urologique de l'Université de Turin, Italie.

Prog Urol. 2000 Sep;10(4):578-82.

OBJECTIVES

The aim of this study was to evaluate retrospectively the preservation of fertility in a number of patients with testis or funicle tumour treated with retroperitoneal lymph node dissection (RPLND).

MATERIAL AND METHODS

Between 1983 and 1998, 41 patients with testis or funicle cancer (mean age 29 years, range 18-58) underwent RPLND at our institution. Clinical staging included abdominal CT scan, chest X-rays and serum tumour markers (alpha FP, beta HCG, LDH). RPLND was performed bilaterally in 14 patients and unilaterally in 13 patients (6 right and 7 left). The nerve sparing technique was used in 14 cases. Ejaculation was evaluated in 39 patients (2 patients died of metastases before the study). Mean follow up was 64 months (range 5-182). Semen was available for 21 patients before RPLND and for 19 patients after RPLND. The "t Student" test was used to compare the semen parameters before and after surgery.

RESULTS

Bilateral RPLND caused loss of ejaculation in 67% of the patients (8/12). Unilateral right and left RPLND allowed to maintain ejaculation in 100% (6/6) and 57% (4/7) of cases respectively. Nerve sparing procedure preserved ejaculation in 100% of the patients (14/14). After RPLND, both mean total sperm count and mean motility rate were not significantly changed (143 +/- 124 x 10(6) vs 128.2 +/- 72 x 10(6) p > 0.05; 40.7 +/- 17.6 vs 48 +/- 15.5%, p > 0.05). The survival rate of the patients treated with RPLND was 95%. None of the patients treated with unilateral (en bloc or nerve sparing) RPLND had relapse.

CONCLUSION

The evolution of surgical technique has notably reduced the andrological complications of the RPLND without affecting the oncological results.

目的

本研究旨在回顾性评估接受腹膜后淋巴结清扫术（RPLND）治疗的若干睾丸或精索肿瘤患者的生育功能保留情况。

材料与方法

1983年至1998年间，41例睾丸或精索癌患者（平均年龄29岁，范围18 - 58岁）在我院接受了RPLND。临床分期包括腹部CT扫描、胸部X线和血清肿瘤标志物（甲胎蛋白、β人绒毛膜促性腺激素、乳酸脱氢酶）。14例患者双侧进行RPLND，13例患者单侧进行RPLND（右侧6例，左侧7例）。14例采用保留神经技术。对39例患者（2例患者在研究前死于转移）的射精功能进行了评估。平均随访时间为64个月（范围5 - 182个月）。RPLND术前有21例患者可获取精液样本，术后有19例患者可获取。采用“t检验”比较手术前后的精液参数。

结果

双侧RPLND导致67%的患者（8/12）射精功能丧失。单侧右侧和左侧RPLND分别使100%（6/6）和57%（4/7）的患者射精功能得以保留。保留神经手术使100%的患者（14/14）射精功能得以保留。RPLND术后，平均总精子计数和平均活动率均无显著变化（143±124×10⁶ vs 128.2±72×10⁶，p>0.05；40.7±17.6 vs 48±15.5%，p>0.05）。接受RPLND治疗的患者生存率为95%。接受单侧（整块切除或保留神经）RPLND治疗的患者均无复发。