Bazzi Wassim M, Raheem Omer A, Stroup Sean P, Kane Christopher J, Derweesh Ithaar H, Downs Tracy M
Department of Surgery, Division of Urology, University of California, San Diego School of Medicine, La Jolla, San Diego, CA, USA.
Urol Ann. 2011 Sep;3(3):115-8. doi: 10.4103/0974-7796.84948.
Approximately 5% of all patients diagnosed with testicular cancer may have contralateral intratubular germ cell neoplasia (ITGCN) and may develop contralateral germ cell tumor. Here, we present a historical review and current literature regarding ITGCN and partial orchiectomy. The PubMed world literature search was performed for articles written in the English language. Search terms used were: Partial orchiectomy and ITGCN, with a return of 322 articles. Articles obtained were from the United States, Germany, Denmark and the Netherlands as well as a few case reports from Australia, France, Turkey and Spain. A critical review of the literature was performed. Partial orchiectomy is an option for the management of testicular malignancy in a select group of patients in whom radical orchiectomy is not desirable, including those with a solitary testicle, bilateral concurrent malignancies and a desire for paternity or being independent from androgen supplementation. Reports have demonstrated the feasibility of partial orchiectomy, but there are strict surgical criteria; tumor less than 2 cm in size, maintenance of cold ischemia, meticulous dissection to maintain testicular blood supply and biopsying of adjacent testicular parenchyma to ensure negative margins and absence of concurrent ITGCN. Partial orchiectomy is followed by testicular irradiation of 18-20 Gy; this radiation dose reduces fertility but maintains leydig cell function with androgen independence. Patients with a history of testicular carcinoma have a 5% chance of developing a metachronous contralateral tumor. Partial orchiectomy is a technically challenging procedure that requires close follow-up, but may represent a reasonable management option in selected patients.
所有被诊断为睾丸癌的患者中，约5%可能患有对侧睾丸原位生殖细胞肿瘤（ITGCN），并可能发展为对侧生殖细胞肿瘤。在此，我们对有关ITGCN和部分睾丸切除术的历史回顾及当前文献进行介绍。通过PubMed对世界范围内用英文撰写的文章进行检索。使用的检索词为：部分睾丸切除术和ITGCN，共检索到322篇文章。获得的文章来自美国、德国、丹麦和荷兰，以及澳大利亚、法国、土耳其和西班牙的一些病例报告。对文献进行了批判性综述。部分睾丸切除术是某些不适合行根治性睾丸切除术的患者管理睾丸恶性肿瘤的一种选择，这些患者包括单睾患者、双侧同时发生恶性肿瘤的患者以及有生育意愿或不依赖雄激素补充的患者。报告已证明部分睾丸切除术的可行性，但有严格的手术标准：肿瘤大小小于2 cm，维持冷缺血状态，细致解剖以维持睾丸血供，并对相邻睾丸实质进行活检以确保切缘阴性且无并发ITGCN。部分睾丸切除术后进行18 - 20 Gy的睾丸照射；这种辐射剂量会降低生育能力，但能维持睾丸间质细胞功能并保持雄激素独立性。有睾丸癌病史的患者有5%的几率发生异时性对侧肿瘤。部分睾丸切除术是一项技术上具有挑战性的手术，需要密切随访，但对于特定患者可能是一种合理的治疗选择。
