妊娠滋养细胞肿瘤膀胱转移的诊断和治疗

目的 评估妊娠滋养细胞肿瘤膀胱转移患者的治疗方法及临床预后。方法 回顾性分析1988～1999年收治的滋养细胞肿瘤(GTT)膀胱转移患者共10例。所有患者均接受了以5-氟脲嘧啶(5-Fu)为主的联合化疗或EMA/CO化疗,同时行5-Fu膀胱灌注。部分患者选择性动脉插管行子宫动脉、膀胱上动脉及髂内动脉栓塞以控制大出血。通过监测β-hCG水平、B超、CT、膀胱镜等辅助检查措施以判断治疗效果。结果10例中2例合并脑转移死亡。1例血生化指标缓解,带瘤存活;7例治愈,其中1例治愈后即失访,6例随诊11-36个月,无复发迹象。结论 滋养细胞肿瘤膀胱转移患者经过正规的全身加局部化疗,疗效较好。选择性动脉插管栓塞可以作为急诊处理膀胱转移大出血患者的首选方法。

Treatment and prognosis of gestational trophoblastic tumor with bladder metastasis

Objective To evaluate treatment and clinical prognosis of patients suffered from gestational trophoblastic tumor (GTT) with bladder metastasis. Methods We retrospectively analyzed ten GTT patients with bladder metastasis treated in our hospital during 1988 ~ 1999. All the patients received 5-Fu combinon chemotherapy or EMA/CO regimen with 5-Fu bladder perfu-sion. Selective arterial embolization of uterine artery, superior vesicle artery and internal iliac artery had been performed to control severe hemorrhage in some of the patients. We evaluated therapeutical effect by monitoring serum B-hCG assay, B-ultrasound, CT and cystoscopy. Results In ten patients, 7 had achieved complete remissions; 1 alive with biochemical remissions but had residua] tumor; 2 died of brain matestasis. Conclusion The therapeutical effect of standard systemic and local chemotherapy for GTT patients with bladder metastasis is appreciated. Selective arterial embolization could be chosen as primary treatment for victims with severe hemorrhage with bladder metastasis.