介入治疗在妊娠滋养细胞肿瘤治疗中的临床应用  

Clinical application of interventional therapy in the treatment of gestational trophoblastic neoplasia

作　　者：张建好[1] 韩新巍[1] 李宗明[1] 胡珍华[2] 张颖[2] 郭瑞霞[2] 李留霞[2] 

机构地区：[1]郑州大学第一附属医院介入科,河南郑州450052 [2]郑州大学第一附属医院妇科,河南郑州450052

出　　处：《实用放射学杂志》2018年第1期94-97,共4页Journal of Practical Radiology

基　　金：河南省医学科技攻关计划项目（201503021）.

摘　　要：目的 探讨妊娠滋养细胞肿瘤（GTN）介入治疗的效果及临床应用价值.方法 选取GTN患者28例,其中18例经氟尿嘧啶＋更生霉素（5-Fu＋KSM）方案化疗2个疗程,β-HCG下降缓慢或无明显下降,子宫病灶无明显缩小;10例应用依托泊苷＋放线菌素-D＋甲氨蝶呤＋四氢叶酸＋长春新碱＋环磷酰胺（EM A-CO）方案化疗2个疗程,出现Ⅳ度骨髓抑制及严重胃肠道反应,无法进行下一周期治疗.所有患者均采用经子宫动脉和/或卵巢动脉化疗灌注（顺铂、依托泊苷、博来霉素）2个疗程,同时应用可吸收明胶海绵颗粒栓塞子宫动脉和/或卵巢动脉,观察β-HCG值的变化及其子宫病灶缩小情况,并观察患者介入治疗前及随访1年内性激素的变化.结果 28例患者应用子宫动脉和/或卵巢动脉化疗灌注及栓塞治疗操作顺利,髂内动脉造影均发现明显肿瘤染色,其中20例患者行双子宫动脉化疗灌注及栓塞,8例患者行双侧子宫动脉并单侧卵巢动脉化疗灌注及栓塞,介入术后第18天测定β-HCG及病灶大小,结果发现2周期治疗后β-HCG下降明显,22例降至正常范围,子宫病灶明显缩小或消失,差异有统计学意义,而性激素水平在介入治疗前及随访1年时无明显变化,差异无统计学意义.结论 应用介入治疗GTN创伤小、效果好,值得临床推广应用.Objective To investigate the effect and clinical value of interventional therapy in the treatment of gestational trophoblastic neoplasia（GTN）.Methods 28 cases of GTN were selected,of which 18 cases were treated with fluorouracil ＋dactinomycin（5-Fu＋KSM）for 2 courses,however,the level of β-HCG and uterine lesions did not significantly reduced.The remained 10 cases were treated with etoposide＋actinomycin-D＋ methotrexate＋ tetrahydrofolate＋ vincristine＋ cyclophosphamide（EMA-CO）chemotherapy for 2 courses,Ⅳ degree of myelosuppression and severe gastrointestinal reactions appeared and had to cease the next cycle of treatment. All patients were treated with uterine artery and/or ovarian arterial infusion（cisplatin,etoposide,bleomycin）for 2 courses,meanwhile, the gelatin sponge particles were used for embolization of uterine arteries and/or ovarian arteries.The β-HCG level,tumor volume, and the changes of sex hormones were tested before and one year after interventional therapy.Results 28 patients underwent transcatheter uterine arterial and/or ovarian arterial chemoembolization and embolization,the internal iliac arteriography showed significant tumor staining.20 patients underwent double uterine arterial infusion and embolization,and 8 patients underwent bilateral uterine arterial and unilateral ovarian arterial infusion and embolization.β-HCG and lesion size were measured on the 18th day after intervention.The results showed that the β-HCG decreased significantly after 2 courses of treatment,and the uterine lesion was reduced or disappeared,with a significant statistical difference,however,sex hormone levels did not changed significantly before interventional therapy and during one year follow-up.Conclusion The interventional treatment of GTN is less invasive,effective,and worthy of clinical application.

关 键 词：妊娠滋养细胞肿瘤 介入治疗 化疗 栓塞 

分 类 号：R714.1[医药卫生—妇产科学] R714.25[医药卫生—临床医学]