Chantilis S J, McQuitty D A, Preminger G M, Marshburn P B
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9032, USA.
J Am Assoc Gynecol Laparosc. 1994 May;1(3):277-82. doi: 10.1016/s1074-3804(05)81024-2.
A 20-year-old woman with complete androgen resistance (AR; 46,XY), underwent prophylactic laparoscopic gonadectomy because of the known increased risk of gonadal malignancy. The procedure was performed with electrocoagulation using a four-puncture technique. Pelvic and abdominal inspection revealed no gonadal or metastatic tumor. The testes and attached structures were retracted medially, and the peritoneum and gonadal vessels were incised after electrocoagulation, thereby removing the gonads from the sidewalls. The gonads were individually placed into a specimen retrieval bag and removed through the suprapubic cannula site. Pathologic examination revealed an occult 8-mm seminoma in the let gonad, as well as bilateral Sertoli cell hamartomas, fallopian tube remnants, and smooth muscle tissue (mullerian remnants) adjacent to the gonads. Postoperatively, tumor markers were normal, and abdominal and pelvic computerized tomographic scans and chest radiographs were negative for possible metastatic disease. This case confirms that laparoscopic removal of testes in women with AR is effective, safe, and quick. Because of normal-appearing gonad may contain an occult tumor, we recommend using a retrieval bag, which may prevent dissemination of potentially malignant cells that may occur with unprotected morcellation.
一名患有完全雄激素抵抗（AR；46，XY）的20岁女性，因已知的性腺恶性肿瘤风险增加而接受了预防性腹腔镜性腺切除术。该手术采用四孔技术进行电凝操作。盆腔和腹部检查未发现性腺或转移性肿瘤。将睾丸及附属结构向内侧牵拉，电凝后切开腹膜和性腺血管，从而从侧壁切除性腺。将性腺分别放入标本回收袋中，通过耻骨上套管部位取出。病理检查显示，左侧性腺有一个隐匿性8毫米精原细胞瘤，以及双侧支持细胞瘤错构瘤、输卵管残余物和性腺附近的平滑肌组织（苗勒氏残余物）。术后，肿瘤标志物正常，腹部和盆腔计算机断层扫描及胸部X线片均未发现可能的转移性疾病。该病例证实，腹腔镜下切除AR女性的睾丸是有效、安全且快速的。由于外观正常的性腺可能含有隐匿性肿瘤，我们建议使用回收袋，这可能会防止在无保护的碎块化过程中可能出现的潜在恶性细胞的播散。
