子宫动脉灌注化学治疗栓塞术联合静脉化学疗法治疗妊娠滋养细胞肿瘤的疗效分析

目的探讨经子宫动脉灌注化学治疗栓塞术联合静脉化学疗法治疗妊娠滋养细胞肿瘤（GTT）的疗效。方法选择GTT患者29例，其中侵蚀性葡萄胎20例，绒毛膜癌9例。患者均采用子宫动脉灌注化学治疗栓塞术加静脉化学治疗，并定期复查及随访，观察患者的治疗效果及不良反应。结果29例患者超选择性动脉插管血管造影全部成功。1例合并大出血者因合并子宫穿孔行子宫动脉灌注化学治疗栓塞术后行子宫全切，其余28例经1～3次子宫动脉灌注化学治疗栓塞加静脉化学治疗后临床痊愈。子宫动脉灌注化学治疗栓塞术后8例患者出现轻中度恶心、呕吐，经补液、止吐、保护胃黏膜等对症处理后症状消失；3例出现不同程度的下腹部疼痛，经解痉治疗3d后好转。静脉化学治疗后20例患者出现中重度恶心、呕吐，经对症处理后好转；18例化学治疗3d后出现骨髓抑制现象，经升白细胞药物治疗后逐渐恢复正常；15例患者出现严重脱发；1例出现严重肝功能异常，停药保肝治疗1周后好转。无1例死亡。结论超选择性子宫动脉灌注化学治疗栓塞术联合静脉化学治疗GTT安全有效，不良反应少，尤其对子宫原发灶或阴道转移灶所致的出血和难治性病例的治疗有一定的优势，值得在临床上推广应用。

Therapeutic effect of uterine artery chemoembolization combined with intravenous chemotherapy on gestational trophoblastic tumor

Objective To explore the curative effect of uterine artery chemoembolization combined with intravenous chemotherapy on gestational trophoblastic tumor（GTT）. Methods Twenty-nine patients with GTT（ including 20 invasive mole and 9 choriocarcinoma patients）were selected. All patients were treated with uterine arterial chemoembolization combined with intravenous chemotherapy, and regularly review and follow-up. The curative effect and adverse reaction were observed. Results ALL patients completed the super selective arterial catheterization angiography successfully. One patient underwent hysterec- tomy after uterine artery chemoembolization due to perforation of uterus. Twenty-eight patients achieved clinical recovery with 1 to 3 times of uterine artery perfusion chemotherapy and intravenous chemotherapy. After uterine artery perfusion chemotherapy embolization,8 patients showed mild to moderate nausea, vomiting and then the symptoms disappeared after given fluid replace- ment, antiemetic, protect the gastric mueosa;3 patients had different degree of pain in the lower abdomen and improvement at 3 days after spasmolysis treatment. After intravenous chemotherapy, 20 patients appeared moderate to severe nausea and vomi- ting,and the symptoms improved after symptomatic treatment; 18 patients appeared bone marrow depression at 3 days after chemotherapy ,and the leukocytes gradually returned to normal after leukogenic drug treatment; 15 patients had serious hair loss;1 patient had severe hepatic dysfunction, and the hepatic function improved after stop giving the chemotherapy drug and given protection liver treatment for 1 week. No patient was died. Conclusion Super selective uterine arterial chemoemboliza- tion combined with intravenous chemotherapy for treatment GTT is safe and effective and less adverse reaction. It has certain dominance in treatment for bleeding caused by the uterine primary or vaginal metastatic lesion or refractory cases especially. Itis worthy of clinical application.