妊娠滋养细胞肿瘤的手术价值

目的　探讨手术在滋养细胞肿瘤治疗中的作用及其决定因素。方法　回顾分析 1991年 1月至2 0 0 3年 1月间我院住院滋养细胞肿瘤 6 0例 ,分为手术组 (32例 )和非手术组 (2 8例 ) ,比较两组相关高危因素 ,并对手术指征进行分析。结果　手术组有较高的高危评分 (7 2 ) ,手术组年龄超过 4 0岁、末次妊娠为足月、绒癌比例、末次妊娠至诊断时间超过 2年均明显高于非手术组 (P <0 0 5 )。手术指征为 :子宫穿孔或阴道大出血、卵巢囊肿蒂扭转 ;耐药或复发、胎盘部位滋养细胞肿瘤、年龄超过 4 0岁或无生育要求。结论　手术在控制出血、耐药复发病例、胎盘部位滋养细胞肿瘤起主要作用 ,而对一般病例也有提高疗效 ,缩短疗程等积极作用。高危因素可以作为决定手术的一项参考指标。

Study on the role of surgery in gestational trophoblastic tumor

Objective To evaluate role and decisive factors of surgical management in women presenting with gestational trophoblastic tumor(GTT).Methods A total of sixty cases of gestational trophoblastic tumor from January 1991 to January 2003 was retrospectively analyzed.The cases were divided into surgical group(32 cases) and non-surgical one(28 cases).The relative high risk factors were compared between two groups.Analysis for the indications of the surgery was made.Results There was a higher score of risk factors in surgical group than that in non-surgical one.The patients in surgical group had a higher percentage of age over 40 years old,term pregnancy for last,choriocarcinoma,the interval between the antecedent pregnancy to the presentation for GTT more than two years,compared with those in non-surgical group(P<0.05).The indications for surgery included uncontrollable vaginal or intraabdominal bleeding,torsion of ovarian cyst,localized chemo-resistant or recurrent disease,and placental site trophoblastic tumor and age over forty years old or undesired pregnancy.Conclusions Surgical treatment plays an important role in control of hemorrhage,chemo-resistant or recurrence and PSTT.It also has a positive role in enhancing the effect and shortening the perid of the therapy in some patients.The high risk factors may be used as a referential index for deciding surgical treatment.