滋养细胞肿瘤手术治疗的分析和探讨(附25例分析)  

The Exploration and Analysis of Operation Treatment of Gestational Trophoblastic Tumor

作　　者：周学惠[1] 

机构地区：[1]江苏省肿瘤医院,江苏南京210009

出　　处：《河南肿瘤学杂志》2004年第6期418-419,共2页Henan Journal of Oncology

摘　　要：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。Objective To evaluate the role of the combination therapy of operation and chemotherapy of trophoblastic tumor and the method dealing with postoperative complication.Methods 25 cases with gestational trophoblastic tumor by hysterectomy was retrospectively analyzed. We put emphasis on dealing with bleeding in the operation and analyzed the prognosis after operation.Results Ten patients whose serum β-HCG is normal and chest-X-ray examination is normal before operation were selected for hysterectomy after short course of chemotherapy because of mass in uterus and/or parauterus. The total of them (10/10) had complete remission. Twelve patients whose serum β-HCG is not normal and chest-X-ray examination is normal before operation were selected for hysterectomy after short course of chemotherapy because of mass in uterus and/or parauterus. 8/12 had complete remission. 2/12 patient had lung matastasis after complete remission two and half a years of operation, but has complete remission after re-chemotherapy. 2/12 had died after operation because of chemo-refractory. Operation time: it is shortest time: 1 hour, longest time: 6.5 hours and average 2.02 hours. Bleeding: it is most 11 400 mL, lessest 50 mL and average 734 mL, among them ≥ 500 mL is 16 cases, <500 mL is 19 cases. 2 cases of large bleeding in operation were saved successfully by ligation of internal iliac artery and plugging lipiodo gauze.Conclusions Although the effective chemotherapy plays a leading role in cure of patients with gestational trophoblastic tumor, hysterectomy remains playing an important role in selected patients. We must pay attention to the mass of parauterus before operation and deal with bleeding actively in the operation.

关 键 词：滋养细胞肿瘤 手术治疗 子宫切除术 

分 类 号：R737.33[医药卫生—肿瘤]