妊娠滋养细胞肿瘤13例手术治疗临床分析

目的探讨手术治疗对妊娠滋养细胞肿瘤的疗效。方法回顾性分析13例妊娠滋养细胞肿瘤的临床资料。结果13例患者中有11例行全子宫切除术,2例行子宫病灶切除术。13例术前彩超均提示子宫存在病变,其中8例（61．5％）术后病理提示为坏死组织,5例（38．5％）可见滋养细胞。8例无滋养细胞残留的患者中2例（25．0％）HCG阳性,5例术后病理可见滋养细胞患者中有4例（80．0％）HCG阳性,两组相比差异无统计学意义（P〉0．05）。结论妊娠滋养细胞肿瘤的治疗虽以化疗为主,但手术治疗仍有重要价值。     

妊娠滋养细胞肿瘤不良结局临床分析

目的分析妊娠滋养细胞肿瘤患者预后的影响因素。方法回顾分析了我院1993年-2006年收治的妊娠滋养细胞肿瘤患者中不良结局的4例病例,对其临床表现、诊断分期和治疗方法及死因进行分析讨论。结果4例死亡病例中3例为晚期绒癌,1例为恶性葡萄胎术后化疗后,4例患者均未能坚持规律化疗,其中1例有严重的化疗副作用,1例出现化疗耐药后接受手术治疗。4例患者最终均死于呼吸循环衰竭,确诊至死亡时间均未超过半年。结论对于妊娠滋养细胞肿瘤,除转移病灶等分期及预后评分因素外,坚持规范合理的化疗,选择合适的手术时机,减少误诊、误治的几率对改善妊娠滋养细胞肿瘤患者的预后有重要意义。     

高危型妊娠滋养细胞肿瘤的评估与治疗

背景与目的：妊娠滋养细胞肿瘤(gestational trophoblastic neoplasm,GTN)是一组起源于胎盘滋养细胞的疾病,因为化疗敏感,绝大多数GTN患者的预后良好。然而,对于高危型GTN由于化疗耐药以及肿瘤复发的存在,其治愈率仅为70%～80%。该研究旨在分析复旦大学附属妇产科医院10年间高危型GTN的诊疗情况。方法：收集2003年1月—2013年1月该院高危型GTN患者的临床资料,从化疗、手术等方面分析其临床特点及其临床转归。结果：10年间我院共收治高危型GTN患者51例,其中5例患者因未完成治疗予以排除,故仅对46例高危型GTN患者予以评估。46例高危型GTN患者,单纯化疗27例,化疗联合手术19例。44例高危型GTN患者接受以EMA-CO(依托泊苷+甲氨蝶呤+Act-D/长春新碱+环磷酰胺)化疗方案为基础的治疗,其中36例患者获得完全缓解(completed response,CR),CR率为81.82%(36/44),8例对EMA-CO耐药;8例EMA-CO化疗方案耐药的患者中,6例更换为EMA-EP(依托泊苷+甲氨蝶呤+Act-D/顺铂+依托泊苷)方案(其中2例接受手术治疗)后获得CR,2例因耐药、疾病进展最终死亡。余2例高危型GTN患者采用其他化疗方案(1例5-FU+KSM,另1例因误诊为持续性异位妊娠接受MTX方案化疗,待手术病理证实为绒癌后由MTX更换为EMA-CO方案)获得CR,故46例患者中,CR率为95.65%(44/46)。19例手术患者中,1例因化疗耐药死亡,余18例均经化疗联合手术治疗获得CR,故手术联合化疗者CR率为94.70%(18/19)。结论：规范的联合化疗对提高高危型GTN的完全缓解率至关重要,手术治疗在高危型GTN治疗中的作用不可忽视。     

耐药性妊娠滋养细胞肿瘤的临床观察

目的 探讨耐药性妊娠滋养细胞肿瘤（GTN）的临床病理特征、治疗及预后。方法 收集15例GTN患者的临床资料进行回顾性分析。结果 15例患者治疗均以化疗为主，其中单纯化疗10例，化疗联合手术5例。治疗结束时获血清学完全缓解12例，部分缓解3例。经6～117个月随访，3例失访，余12例无复发或死亡。结论 耐药性GTN的治疗以化疗为主。对于病灶持续存在或血清人绒毛膜促性腺激素β亚单位下降不理想的患者，联合手术治疗可改善预后。     

介入化疗在高危妊娠滋养细胞肿瘤治疗中的应用

目的:探讨介入化疗在高危妊娠滋养细胞肿瘤治疗中的应用。方法:2008年7月至2012年7月,在我院进行介入化疗的高危GTN患者21例。末次妊娠的性质来源于葡萄胎者10 例,流产后8例,中孕引产后1例,足月产后2 例。21例高危GTN患者均采用EMA-EP介入化疗方案, VP16 100mg/m2＋0.9%NS 40ml,d8介入;DDP 80mg/m2＋0.9%NS 100ml,d8介入。介入化疗前后均行妇科检查、彩色多普勒超声检查、胸部X 线或肺部CT 检查、血β-HCG 水平测定以明确诊断和进行疗效判定。结果:21例患者共行39次动脉插管,其中双侧子宫动脉插管24次,支气管动脉插管8次,左侧卵巢动脉插管2次,肠系膜下动脉插管2次,膀胱上动脉插管2次,阴部内动脉插管1次。介入化疗的有效率为95.2%。结论:介入化疗能提高高危GTN患者的化疗效果,降低化疗的耐药问题,有可能缩短治疗疗程,更重要的是可以保留脏器功能。对于高危GTN患者,介入化疗提供了新型、高效的方法。     

选择性动脉介入术治疗妊娠滋养细胞肿瘤临床分析

目的:探讨选择性动脉栓塞(selective arterial embolization,SAE)术和动脉灌注化疗栓塞术在妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)治疗中的应用价值。方法:回顾性分析2010年7月至2020年1月27例于首都医科大学附属北京妇产医院行SAE治疗的GTN患者临床资料,分为动脉灌注化疗栓塞组(n=14)和单纯动脉栓塞组(n=13),所有患者行SAE治疗联合静脉化疗。超声检查子宫病灶大小改变、检测血清人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)下降水平及保留生育功能情况。结果:患者平均年龄为35.37(19～51)岁,17例活动性出血患者行SAE治疗后出血均得到有效控制,患者行静脉化疗的总疗程中位数为4个疗程,治疗过程中行子宫切除为6例。两组患者行SAE联合静脉化疗1个疗程,超声检查评定治疗有效率为51.8%(14/27),两组间比较差异无统计学意义(P=0.413);血清β-HCG平均下降(2.07±0.91)个对数,两组间比较差异无统计学意义(P=0....     

妊娠滋养细胞肿瘤的病理

妊娠滋养细胞肿瘤的病理浙江医科大学妇产科医院（３１０００６）赵承洛妊娠滋养细胞肿瘤（ｇｅｓｔａｔｉｏｎａｌｔｒｏｐｈｏｂｌａｓｔｉｃｔｕｍｏｒ，ＧＴＴ）具有胚胎绒毛滋养细胞的一些生理特性，如向母体组织血管浸润，放逐的绒毛滋养细胞可在母体血管内游走，因...     

氟脲嘧啶脱氧核苷治疗妊娠滋养细胞肿瘤疗效观察

目的探讨氟尿嘧啶脱氧核苷(floxuridine,FUDR,氟苷)治疗妊娠滋养细胞肿瘤的疗效和毒性.方法观察组(A组)25例,接受FUDR治疗;对照组(B组)30例,接受5-Fu治疗.结果 A、B两组治愈率分别为92.0%(23/25)及93.3%(28/30,P＞0.05).A组消化道反应、脱发、口腔溃疡、局部静脉炎发生率低于B组(P＜0.01).结论 FUDR治疗滋养细胞肿瘤疗效确切,毒性较5-Fu低,值得临床推广应用.     

高危妊娠滋养细胞肿瘤的治疗进展

妊娠滋养细胞肿瘤（gestational trophoblastic neoplasms,GTN）是来源于胎盘部位滋养细胞的恶性肿瘤,好发于年轻女性,因对化疗高度敏感,治愈率高,其中高危型患者治愈率达80%～90%,但也有部分患者因发生耐药或复发,或者发生全身脏器如肝、脑等特殊部位转移而治疗无效。本文对高危型GTN临床治疗文献进行综述,总结该领域的研究进展。     

低危妊娠滋养细胞肿瘤的治疗进展

由于血绒毛膜促性腺激素（HCG）监测肿瘤的高敏感性和特异性,及化疗的有效性,使妊娠滋养细胞肿瘤（gestational trophoblastic neoplasia,GTN）成为迄今预后最好的恶性肿瘤,低危GTN治愈率为100％,而高危患者也可达86％。因此对于低危GTN患者来说,治疗方案的选择更需考虑患者的生活质量。     

恶性滋养细胞肿瘤预后因素探讨

目的探讨不同治疗措施对恶性滋养细胞肿瘤预后的影响.方法对1994年1月～2000 年12月我院收治的58例恶性滋养细胞肿瘤患者的治疗措施及治疗效果进行回顾分析,随诊1～8年,比较刮宫次数≤2次或＞ 2以上、是否规范化疗及选择合理手术时机的治疗效果.结果恶性滋养细胞肿瘤患者刮宫次数≤2次与刮宫次数＞ 2次的疗效比较、是否选择合理手术时机的疗效比较差异均有显著性(P<0.05);不规范化疗与规范化疗的疗效比较差异有极显著性(P<0.01).结论正确的治疗措施即避免多次刮宫、进行规范化疗及选择合理手术时机是恶性滋养细胞肿瘤预后的重要影响因素.     

The outcome of patients with low risk gestational trophoblastic neoplasia treated with single agent intramuscular methotrexate and oral folinic acid

BackgroundGestational trophoblastic neoplasia (GTN) persisting despite local treatment requires chemotherapy. In 2000, the revised International Federation of Gynaecology and Obstetrics (FIGO)/World Health Organisation (WHO) staging system was introduced, classifying patients as at ‘low’ or ‘high’ risk for resistance to single agent treatment.Patients and methodsWe have evaluated the complete response rates of patients with low risk GTN treated with 2 weekly intramuscular (IM) methotrexate 50 mg four doses days 1, 3, 5, 7 and oral folinic acid 15 mg days 2, 4, 6, 8 (MTX/FA). Patient data between January 2000 and December 2011 were collated and the relationships between FIGO/WHO risk score and outcomes evaluated.ResultsTwo hundred and eighty nine patients were treated with single agent IM MTX/FA and assessed for treatment response. 29/36 (81%) patients with a FIGO/WHO total score of 6 developed resistance to MTX/FA compared with 87/253 (34%) patients with a score of 0–5 (p ? 0.0001). Significantly higher rates of resistance were found for patients with an hCG level of >100,000 iu/l compared to an hCG level of <100,000 iu/l (84% versus 34% p ? 0.0001). All patients were eventually cured with chemotherapy or surgical salvage.ConclusionsPatients with low risk GTN that have a FIGO/WHO score of 6 or hCG level of >100,000 iu/l have high rates of resistance to MTX/FA and require further treatment. Revision of the FIGO/WHO scoring system may be appropriate to enable selection of more effective first line chemotherapy.     

Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Gestational trophoblastic neoplasia (GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma (CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor (PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases. The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics (FIGO) 2000 criteria: four or more plateaued human chorionic gonadotropin (hCG) concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However, the latter reason for treatment is no longer used by many centers. In addition, GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1 cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate (MTX) or Actinomycin-D (Act-D), can cure about 70% of patients with FIGO/World Health Organization (WHO) prognosis risk score ≤ 6 (low risk), reserving multiple agent chemotherapy, such as EMA/CO (Etoposide, MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7 (high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death, allow the healing and maintenance of the reproductive potential of these women.     

不同分期绒癌化疗的回顾性临床疗效对比分析

目的：探讨绒癌临床各期综合治疗的预后及毒副作用发病率的差异。方法：收集2002-01-01-2009-12-31山东医学高等专科学校附属医院收治绒癌患者116例，回顾性分析不同期别经化疗等综合治疗后的临床转归。结果：绒癌总完全缓解率72．4％（84／116），其中I和Ⅱ期均为100．0％（23／23，25／25），Ⅲ期为66．7％（30／45），IV期为26．1％（6／23）。4种期别化疗毒副作用的发病率比较结果显示，伪膜性肠炎发生率差异有统计学意义，P〈0．001；骨髓抑制、口腔溃疡和肝功异常的发生率差异无统计学意义，P值分别为0．692、0．999和0．634。II和Ⅳ期患者总生存比较差异有统计学意义，P=0．009。Ⅲ期患者单纯化疗与手术联合化疗的总生存期比较差异无统计学意义，P=0．781；IV期患者单纯化疗与手术联合化疗的总生存期比较差异无统计学意义，P=0．615。结论：绒癌对化学治疗敏感，但≥Ⅱ期患者经多药物联合化疗其完全缓解率较早期患者明显降低。不同期别患者化疗药物的毒副作用发病率差异无统计学意义。Ⅲ期患者5年总生存期明显高于Ⅳ期患者。手术联合化疗不能提高绒癌的总生存期。     

A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia

The majority of women requiring chemotherapy for gestational trophoblastic disease (GTN) are cured with their initial chemotherapy treatment. However, a small percentage either become refractory to treatment, or relapse after the completion of treatment. This study investigates the characteristics and outcome of these patients. Patients were identified from the Charing Cross Hospital GTD database. The outcome of these patients with relapsed disease was compared to those with refractory disease. Between 1980 and 2004, 1708 patients were treated with chemotherapy for GTN. Sixty (3.5%) patents relapsed following completion of initial therapy. The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86-100%). The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 66-96%: P<0.05), respectively. Eleven patients were identified who failed to enter remission and had refractory disease. These patients had a worse outcome compared to patients with relapsed disease (5-year survival 43% (95% CI:12-73% P<0.01)). The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients.     

Comparison of MACT and 5Fu+ACT-D chemotherapy regimens in the treatment of low-risk gestational trophoblastic neoplasia

The study aimed to compare the efficacy of methotrexate (MTX) cervical injections + actinomycin-D (ACT-D)(MACT) and 5-fluorouracil (5-Fu) + actinomycin-D (5-Fu plus ACT-D) chemotherapy regimens for low-risk gestational trophoblastic neoplasia (LR-GTN). Clinical data from 66 LR-GTN patients, admitted to the Beijing Obstetrics and Gynecology Hospital from January 2010 to April 2012, were analysed retrospectively. In total, 32 patients were treated with a MACT therapeutic regimen and the remaining 34 with a 5Fu + ACT-D therapeutic regimen. Complete remission rates (CR), duration of treatment, hospital stay and toxicity effects were compared. There was no statistical difference in CR for the MACT (90.63%) or the 5-Fu plus ACT-D (100%) therapeutic regimens (p = 0.0676) or in the duration of treatment [MACT (3.50) or 5-Fu plus ACT-D (3.71; p = 0.2021)]. Moreover, the hospital stay in the 5-Fu plus ACT-D group (32.88 days) was significantly longer than for the MACT group (22.09 days; p ＜ 0.001). Furthermore, the degree of myelosuppression, nausea and vomiting, diarrhoea, stomatitis and alopecia was more severe in the 5Fu + ACT-D group (p ＜ 0.01). However, there was no statistical difference in the severity of liver function damage between the two groups. A shorter hospital stay, lower hospitalization cost and slightly more toxic effects were observed in LR-GTN patients treated with the MACT therapeutic regimen. We suggest that the MACT regimen should be used as first-line chemotherapy for LR-GTN.