复发性妊娠滋养细胞肿瘤的临床分析  

Clinical analysis of recurrent gestational trophoblastic neoplasia

作　　者：周薇[1] 钱建华[1] 陈亚侠[1] 万小云[1] 吕卫国[1] 谢幸[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,杭州310006

出　　处：《现代妇产科进展》2011年第1期23-26,29,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金批准项目(No:T20090718);浙江省自然科学基金资助项目(No:J20091445);浙江省重大科技专项和优先主题项目(No:I20100055)

摘　　要：目的:探讨复发性妊娠滋养细胞肿瘤(recurrent gestational trophoblastic neoplasia,recurrent GTN)的诊断方法与治疗措施。方法:回顾分析2000年6月～2009年6月浙江大学附属妇产科医院住院的复发性滋养细胞肿瘤21例患者的临床资料,并结合复习文献进行探讨。结果:在21例患者中,16例(76.2%)为单次复发,5例(23.8%)复发2次或者2次以上。复发的时间间隔分别为2个月～20年不等,其中12例(57.1%)在12个月内复发;9例(40.9%)在12个月后复发(其中4例在12～24个月复发)。16例为单次复发患者中13例直接采用EMA-CO化疗方案,10例经过3～7个疗程后达到血清学完全缓解(serologic comple teremission,SCR),2例效果不理想者采用EP-EMA化疗方案(1例辅以手术治疗)均在5个疗程后达到SCR,1例由于骨髓抑制严重,主动放弃治疗。5例多次复发患者中4例为2次复发,1例3次复发。4例2次复发的患者中,3例在第2次复发时采用EMA-CO化疗方案并在5～10个疗程后达到SCR,1例新发病灶切除术后放弃治疗。1例3次复发患者,3次治疗均达到SCR。21例患者中采用手术辅助治疗的有10例(47.6%),其中初次治疗时有5例(均为子宫切除),复发后7例[3例切除子宫,1例切除子宫病灶,2例切除转移病灶(2例初次治疗时切除子宫),1例分别切除转移病灶和子宫(2次复发,每次复发时手术)],切除子宫或者病灶后均得到不同程度的缓解。结论:以EMA为基础的联合化疗对复发性GTN患者有效,手术可作为复发性GTN的治疗辅助方式。Objectives：To analyze retrospectively clinical character of recurrent gestational trophoblastic neoplasia（GTN）and discuss the management of these patients.Method：Clinical data of 21 cases of recurrent gestational trophoblastic neoplasia from June 1st,2000 to June 1st,2009 in Women＇s Hospital Affiliated to School of Medicine of Zhejiang University were retrospectively analyzed,and the management with these cases were further discussed.Results：In the 21 cases,recurrence interval ranged from 2 months to 20 years.16 cases（76.2%） were single recurrence,and the other 5 cases（23.8%） relapsed 2 times or more than 2 times.Relapsed gestational trophoblastic neoplasia had been treated in our hospital.In the 21 cases,12 cases（57.1%） relapsed within 12 months;and 9 cases（40.9%） relapsed after 12 months（4 cases relapsed between 12 to 24 months）.In the 16 single recurrence cases,13 cases used chemotherapy with EMA-CO regimen,and 10 cases were in SCR after 3～7 cycles treatment.2 cases were replaced whit EP-EMA regimen（1 case whit surgical adjuvant therapy）and achieved SCR after 5 cycles treatment.1 case refused to continue treatment.In the 5 multiple relapsed cases,4 cases were 2 times recurence and 1 case was 3 times recurrence.In the 4 cases,3 cases were in SCR after 5～10 cycles with EMA-CO regimen and 1 case gave up treatment after surgery.The case of 3 times recurrence reached the SCR after every treatment.In the 21 cases,10 cases（47.6%） used surgical adjuvant therapy.5 cases underwent hysterectomy at initial treatment.In the 7 surgery cases,3 cases underwent hysterectomy;1 case uterine lesions excision;and 2 cases metastas excision（hysterectomy as initial treatment）;and 1 case underwent successively metastas excision and hysterectomy at the time of local relapse.These cases achieved remission to some degree after surgical treatment.Conclusion：EMA-based combination chemotherapy is effective in GTN patients.Surgery can be used as supplementary treatment for recurrent GTN.

关 键 词：妊娠滋养细胞肿瘤 复发性 化疗 手术治疗 

分 类 号：R737.33[医药卫生—肿瘤]