介入栓塞在妊娠滋养细胞肿瘤继发子宫动静脉瘘治疗中的应用价值  

The value of interventional embolization in the treatment of gestational trophoblastic neoplasia with uterine arteriovenous fistula

作　　者：赵维敬[1] 张晓峰[1] 梁宇霆[1] 王克扬[1] 王新莲[1] ZHAO Weijing;ZHANG Xiaofeng;LIANG Yuting;WANG Ke yang;WANG Xinlian(Department of Radiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院放射科,北京100006

出　　处：《实用放射学杂志》2020年第6期956-959,共4页Journal of Practical Radiology

基　　金：首都医科大学附属北京妇产医院中青年学科骨干培养专项项目(fcyy201617)。

摘　　要：目的探讨介入栓塞在妊娠滋养细胞肿瘤(GTN)继发子宫动静脉瘘(AVF)治疗中的应用价值。方法回顾性选取GTN继发子宫AVF患者35例,其中侵袭性葡萄胎28例,绒毛膜癌7例。根据不同治疗方案分组:子宫介入栓塞或动脉灌注化疗栓塞联合多药静脉化疗(介化组)16例,多药静脉化疗(化疗组)19例,比较2组疗效。结果2组在年龄、临床分期、肺转移、预后评分、血清人绒毛膜促性腺激素β亚单位(β-HCG)、初始化疗方案无显著性差异(P>0.05)。2组血清学缓解率分别为100%、63.2%,介化组明显好于化疗组(P=0.009)。当血清β-HCG降至正常水平,2组患者所用的疗程数有显著性差异(P=0.010),接受3个以上疗程的患者在介化组占6.2%,在化疗组占47.4%。2组初次化疗后血β-HCG下降速度无显著性差异(P=0.109)。结论子宫介入栓塞或动脉灌注化疗栓塞能够提高GTN继发子宫AVF患者的化疗效果,减少静脉化疗疗程,是值得考虑的辅助治疗手段。Objective To investigate the value of interventional embolization in the treatment of gestational trophoblastic neoplasia(GTN)with uterine arteriovenous fistula(AVF).Methods The clinical data of 35 patients(invasive mole 28,choriocarcinoma 7)from GTN with uterine AVF was collected retrospectively.The patients were divided into two groups according to different treatment regimens.One group(16 patients,interventional-chemotherapy group)was treated with uterine interventional embolization or arterial infusion chemoembolization combining with multidrug intravenous chemotherapy,and another group(19 patients,chemotherapy group)was treated with multidrug intravenous chemotherapy.Then,the treatment effect between the two groups was compared.Results There were no significant differences in age,clinical stage,lung metastasis,prognostic score,the bloodβ-HCG and initial chemotherapy regimen between the two groups(P>0.05).The serologic complete remission rates of the two groups were 100%and 63.2%,respectively,and the interventional-chemotherapy group was significantly better than the chemotherapy group(P=0.009).When the bloodβ-HCG dropped to normal level,there was a significant difference in the number of treatment courses between the two groups(P=0.010).6.2%of patients received more than 3 courses in the interventional-chemotherapy group,while 47.4%in the chemotherapy group.There was no significant difference in the falling speed of the bloodβ-HCG between the two groups after the first chemotherapy(P=0.109).Conclusion The uterine interventional embolization or arterial infusion chemoembolization can improve the effect of chemotherapy and reduce the treatment courses of intravenous chemotherapy for patients of GTN with uterine AVF.It is worth considering as an adjuvant therapy.

关 键 词：妊娠滋养细胞肿瘤 动静脉瘘 化疗 栓塞 

分 类 号：R714.25[医药卫生—妇产科学] R815[医药卫生—临床医学]