子宫切除对治疗滋养细胞肿瘤价值的探讨

目的 评价子宫切除手术在滋养细胞肿瘤治疗中的作用。方法 对６８例行子宫切除术的滋养细胞肿瘤病例进行回顾性分析,其中侵蚀性葡萄胎３０例,绒癌３８例,结果２３例因年龄偏大,且无生育要求,术前经短暂化疗后,择期行全子宫切除术,２２例获完全缓解,总平均化疗程数为４．２。２７例因产生化疗耐药,且考虑病灶主要局限于子宫,在化疗的同时进行了全子宫切除术,２０例（７４．１％）获完全缓解,总平均化疗程数为９．４。     

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。     

绒癌或侵蚀性葡萄胎保留生育功能手术的评价

我院 196 3年 1月～ 1998年 8月行保留生育机能手术治疗 19例恶性滋养细胞肿瘤患者 ,现报告如下。一、临床资料19例患者中 ,年龄最大 31岁 ,最小 2 0岁 ,平均年龄 2 5 .2岁。其中侵蚀性葡葡胎 (侵葡 )Ⅰ期 2例 ,Ⅱａ期 2例 ,Ⅲａ期6例。绒癌Ⅰ期 3例 ,Ⅲａ期 3例 ,Ⅲｂ期 2例 ,Ⅳ期 1例。手术适应证 :患恶性滋养细胞肿瘤 ,经多疗程化疗子宫内仍存在 1～ 2个病灶 ,血中人绒毛膜促性腺激素 (ＨＣＧ)水平不很高 ,子宫外病灶少或无 ,患者无法再耐受多疗程化疗 ,要求保留生育功能者 ,行子宫内病灶剔除术 ;恶性滋养细胞肿瘤引起的子宫穿孔 ,行修补…     

滋养细胞肿瘤手术治疗的分析和探讨（附25例分析）

目的本文分析滋养细胞肿瘤手术与化疗相结合的治疗方法及手术后并发症的处理方法。方法回顾分析我院25例手术治疗滋养细胞肿瘤的情况，重点分析术中大出血的处理方法，并对患者术后预后情况进行分析。结果10例术前血β-HCG正常范围，肺X线片阴性，因子宫或宫旁占位行子宫切除术后，10／10完全缓解；12例术前血β-HCG不正常，肺X线片阴性，因子宫或宫旁占位行子宫切除术后，8／12完全缓解，2／12完全缓解后2年半再次肺转移，经化疗后完全缓解，2／12术后化疗耐药死亡。手术时间：最短1h，最长6．5h，平均2．02h。出血量：最多11400mL，最少50mL，平均734mL，其中大于500mL6例，小于500mL19例。2例术中大出血，经髂内动脉结扎碘仿纱布盆底填塞，抢救成功。结论滋养细胞肿瘤的治疗以化疗为主，手术在某些情况下仍有重要价值。术前应重视子宫旁转移瘤，术中积极处理大出血。     

滋养细胞肿瘤手术治疗的分析和探讨(附25例分析)

目的　本文分析滋养细胞肿瘤手术与化疗相结合的治疗方法及手术后并发症的处理方法。方法　回顾分析我院 2 5例手术治疗滋养细胞肿瘤的情况 ,重点分析术中大出血的处理方法 ,并对患者术后预后情况进行分析。结果　 10例术前血 β HCG正常范围 ,肺X线片阴性 ,因子宫或宫旁占位行子宫切除术后 ,10 /10完全缓解 ;12例术前血 β HCG不正常 ,肺X线片阴性 ,因子宫或宫旁占位行子宫切除术后 ,8/12完全缓解 ,2 /12完全缓解后 2年半再次肺转移 ,经化疗后完全缓解 ,2 /12术后化疗耐药死亡。手术时间 :最短 1h ,最长 6 5h ,平均 2 0 2h。出血量 :最多 114 0 0mL ,最少 5 0mL ,平均 73 4mL ,其中大于 5 0 0mL 6例 ,小于 5 0 0mL 19例。 2例术中大出血 ,经髂内动脉结扎碘仿纱布盆底填塞 ,抢救成功。结论　滋养细胞肿瘤的治疗以化疗为主 ,手术在某些情况下仍有重要价值。术前应重视子宫旁转移瘤 ,术中积极处理大出血。     

妊娠滋养细胞肿瘤子宫病灶大出血的处理

妊娠滋养细胞肿瘤因肿瘤细胞具有亲血管性，极易因肿瘤侵袭血管而发生子宫病灶大出血。子宫病灶大出血较凶险，但保守治疗难以奏效，处理上比较棘手，其中放射介入动脉栓塞术、手术治疗为常用的两种方法。本文对妊娠滋养细胞肿瘤子宫病灶大出血的放射介入动脉栓塞术和手术治疗的应用效果、注意事项及出血处理后的治疗研究进展进行阐述。     

宫颈癌广泛性全子宫切除术后下肢深静脉血栓形成原因分析

目的 分析因宫颈癌行广泛性全子宫切除的患者术后发生下肢深静脉血栓的高危因素.方法总结本院2009年至2011年收治的32例因宫颈癌行广泛性全子宫切除术后发生下肢深静脉血栓（deep vein thrombosis,DVT）形成的患者情况,同时筛选了同时期年龄、病变分期相匹配的56例因宫颈癌行广泛性全子宫切除术的患者作为对照组,使用线性回归分析两组之间的差异,计数资料用相对数表示,有序资料比较采用秩和检验.结果 DVT组与对照的平均手术时间为（3.5 ±1.2）小时和（3.0±0.8）小时,围手术期化疗患者占比为35％和23％,术中失血量为（645±120） ml和（400 ±200） ml,三项指标差异均具有统计学意义（P＜0.05）;但患者年龄和疾病分期无明显差异.结论 手术时间较长、术中出血较多、围手术期接受化疗为宫颈癌行广泛性全子宫切除的患者罹患静脉血栓的高危因素.早发现、早治疗能获得较好的治疗效果.     

子宫滋养细胞肿瘤彩色多普勒血流显像类型与临床治疗及预后

彩色多普勒血流显像(CDFI)在妊娠滋养细胞肿瘤的诊断及化疗疗效观察评估方面具有重要价值。我们分析42例滋养细胞肿瘤不同的子宫CDFI特征,比较各组间化疗治愈率、疗程数、手术率,以总结经验,为临床治疗手段的选择提供参考和依据。一、资料与方法1.临床资料:从我院2001年8月至2004年6月住院的滋养细胞肿瘤患者中,筛选病灶局限于子宫无远处转移的初治病例42例。年龄18~47岁,中位年龄34岁。按照宋鸿钊等的临床诊断及分期标准,其中侵蚀型葡萄胎27例,绒毛膜癌11例。2.方法:采用Aspen彩色超声诊断仪,探头频率3.5MHz,于化疗前进行检测,依据子…     

恶性滋养细胞肿瘤化疗后病人再生育问题

恶性滋养细胞肿瘤化疗后病人再生育问题中国医学科学院北京协和医院妇产科（１００７３０）宋鸿钊，杨秀玉长期以来，治疗恶性滋养细胞肿瘤病人都以切除子宫为主要手段。即使在找到了有效的化学疗法之后，也因子宫是原发病灶，多数人仍主张切除子宫。这样病人虽获得了生命...     

复发性卵巢室管膜瘤一例报告及文献复习

1 病例报告 患者女,37岁.2002年因子宫肌瘤及右卵巢囊肿在基层医院行子宫次全切除和右附件切除术,病理确诊为移行细胞癌,术后化疗5个周期.患者第1次手术后4年无不适.     

Gestational trophoblastic disease

Opinion statement Patients diagnosed with molar pregnancy are treated by either suction curettage or hysterectomy, depending on their desire to preserve fertility. We use single-agent chemotherapy, preferably methotrexate, to treat low- or moderate-risk persistent trophoblastic tumors. High-risk patients who have metastatic disease are treated primarily with combination chemotherapy and, as indicated, adjuvant radiotherapy or surgery. We perform a hysterectomy in all cases of placental-site trophoblastic tumors; combination chemotherapy is used if there is evidence of metastatic disease.     

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。     

Primary non-Hodgkin,s Lymphoma of the Uterine Cervix

Primary malignant lymphoma of the cervix is a rare disease. Because the number of reports of this cancer is limited, there is no consensus on its management, prognosis or the efficacy of various treatments. Primary malignant lymphoma of the cervix stage Ib was diagnosed in a woman aged 25 years. The patient was treated with 6 courses of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). Clinical and pathological responses were complete. This case supports current thinking in that, in selected young patients with primary malignant lymphoma of the cervix who desire to preserve fertility and ovarian functions, combination chemotherapy regimens such as CHOP are the treatment of choice.     

Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran

Objective

This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm.

Methods

During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients'' records and pathologic reports were analyzed by the chi-square and Fisher''s exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence.

Results

Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different.

Conclusion

The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.     

妊娠滋养细胞肿瘤治疗后的妊娠结局

妊娠滋养细胞肿瘤化疗治愈率较高,治愈后的再次妊娠结局非常值得关注.妊娠滋养细胞肿瘤化疗后避孕1年后再妊娠,妊娠结局与一般人群相似,近年研究发现化疗完成至首次妊娠的时间间隔影响妊娠结局,对化疗后6个月内妊娠的患者需严密监视,建议化疗后避孕1年后再次妊娠.     

Gestational trophoblastic disease: does central nervous system chemoprophylaxis have a role?

In the UK there are standardized surveillance procedures for gestational trophoblastic disease. However, there are differences in practice between the two treatment centres in terms of definition of persistent gestational trophoblastic disease, prognostic risk assessment and chemotherapeutic regimens. The role of prophylactic chemotherapy for cerebral micrometastatic disease in persistent gestational trophoblastic disease is unclear. We have analysed the outcome of 69 patients with lung metastases who elsewhere might have received prophylactic intrathecal chemotherapy. Of the 69 patients, 67 received intravenous chemotherapy only. The other two patients had cerebral metastases at presentation. One patient who received only intravenous chemotherapy subsequently developed a cerebral metastasis, but this patient's initial treatment was compromised by non-compliance. This experience supports our current policy of not treating patients with pulmonary metastases, without clinical evidence of central nervous system (CNS) involvement, with prophylactic intrathecal therapy.     

静脉及腹腔联合化疗治疗滋养细胞肿瘤的探讨（附3例报道）

目的：探讨滋养细胞肿瘤治疗的另一种给药途径。方法：总结2000年以来以静脉联合腹腔化疗给药方式治疗的3例滋养细胞肿瘤患者治疗情况。结果：用常规给药途径治疗效果不佳的3例患者均取得满意疗效。其中2例痊愈出院，1例继续治疗。结论：静脉联合腹腔化疗对子宫穿破、盆腹腔病灶及术后局部复发的滋养细胞肿瘤患者，是一种有效的治疗方案。     

恶性滋养细胞肿瘤合并脑转移的治疗探讨：附8例分析

报道恶性滋养细胞肿瘤合并脑转移8例.静脉化疗合并~(60)Co全脑照射4例,3例脑转移瘤完全消失,随访至少1年未见复发,另1例照射后4个月死于肺转移.静脉化疗合并鞘内注射2例,1例无效死亡,1例脑转移瘤缩小,随访1年半仍带瘤存活.1例仅行静脉化疗者无效死亡.因此,恶性滋养细胞肿瘤合并脑转移行全脑照射同时静脉化疗,方法简便,效果较好.