Terachi T, Arai Y, Maeda S, Takeuchi H, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University.
Hinyokika Kiyo. 1992 Oct;38(10):1191-4.
A 32-year-old man who had left testicular embryonal carcinoma with low volume left para-aortic lymph node swelling was treated initially with 3 courses of cisplatin-based combination chemotherapy. Pathological findings of the primary lesion revealed no yolk sac element and no elevation of serum alpha fetoprotein (alpha-FP) and beta-human chorionic gonadotropin (beta-HCG) levels even before the left orchiectomy. Therefore, the retroperitoneal lymph node dissection (RPLND) was performed despite marked shrinkage of the enlarged nodes. The L1-3 lumber splanchnic nerves from the right sympathetic truncus were detected in the intra-aortocaval region to prevent impairment of ejaculatory function and the lymph nodes in the area were removed one by one between the preserved neurofibers. On the other hand, the left para-aortic lymphatic tissue which included enlarged nodes was dissected in en bloc manner. The pre-aortic lymphatic tissue caudally to the inferior mesenteric artery was preserved not to be touched. The patient ejaculated normally 3 weeks after the RPLND. Treatment of stage IIA disease with chemotherapy first might be helpful in performing RPLND, if necessary, with keeping both ejaculatory function and radicality.
一名32岁男性，患有左侧睾丸胚胎癌，伴有少量左侧腹主动脉旁淋巴结肿大，最初接受了3个疗程的以顺铂为基础的联合化疗。原发灶的病理检查结果显示，即使在左侧睾丸切除术前，也未发现卵黄囊成分，血清甲胎蛋白（α-FP）和β-人绒毛膜促性腺激素（β-HCG）水平也未升高。因此，尽管肿大的淋巴结明显缩小，仍进行了腹膜后淋巴结清扫术（RPLND）。在主动脉腔静脉区域检测到来自右侧交感干的L1-3腰内脏神经，以防止射精功能受损，并在保留的神经纤维之间逐一切除该区域的淋巴结。另一方面，将包括肿大淋巴结在内的左侧腹主动脉旁淋巴组织整块切除。肠系膜下动脉尾侧的主动脉前淋巴组织予以保留，未受触动。患者在RPLND术后3周射精正常。对于IIA期疾病，先进行化疗可能有助于在必要时进行RPLND，同时保持射精功能和根治性。
