妊娠滋养细胞肿瘤泌尿系转移患者的治疗及预后

目的评估妊娠滋养细胞肿瘤（GTN）泌尿系转移患者的治疗及预后。方法对1987年1月至2005年12月在北京协和医院就治的19例GTN泌尿系转移患者进行回顾性分析,其中膀胱转移10例,肾转移9例,同时发生膀胱及肾转移的有2例。所有患者均接受以5-氟尿嘧啶（5-FU）为主的联合化疗或EMA-CO化疗,5例患者同时行5-FU膀胱灌注。7例患者行选择性动脉插管栓塞或化疗。5例合并脑转移的患者接受联合化疗同时行甲氨蝶呤（MTX）鞘内注射。结果经过2～22个疗程的化疗后19例患者中11例完全缓解,2例血生化指标缓解带瘤存活,2例住院化疗期间病情恶化放弃治疗,4例合并脑转移死亡。结论GTN膀胱转移患者经过正规的全身加局部化疗预后较好,而肾转移的患者预后相对较差。选择性动脉插管栓塞可以作为急诊处理膀胱转移合并阴道转移大出血患者的首选方法。

Treatment and prognosis of gestational trophoblastic neoplaisa with urinary system metastasis

Objective To evaluate characteristics,treatment and clinical prognosis of gestational trophoblastic neoplasia patients with urinary system metastasis. Methods We retrospectively analyzed 19 GTN patients with urinary system metastasis treated in our hospital during 1987-2005. All patients received 5-FU combined chemotherapy or EMA/CO regimen, and 5 of them were treated with 5-FU bladder perfusion. Selective arterial embolization had been performed to control severe hemorrhage in 7 patients. Intrathecal MTX chemotherapy was utilized for 5 patients with intracranial metastases. Results After 2 - 22 courses of chemotherapy, among 19 patients, 11 had achieved complete remission; biochemical remission was obtained in 2 patients who were alive with residual tumor;4 patients with brain metastases died; the other 2 patients developed drug resistance and their conditions grew worse, then they gave up treatment and left our hospital. The survival rate was 68%. Conclusion The curative effect of standard systemic and local chemotherapy for GTN patients with urinary metastasis is appreciated. The prognosis of the patients complicated with bladder metastasis is better than those complicated with kidney metastasis. Gestational trophoblastic neoplasia cells are transferred to kidney mainly by blood circulation. Selective arterial embolization can be selected as primary alternative for victims of severe hemorrhage of bladder or vagina metastasis.