特殊病理类型妊娠滋养细胞肿瘤的治疗  

Treatment for special pathological types of gestational trophoblastic neoplasia.

作　　者：王芬芬[1] 鲍可纯 程晓东[1] WANG Fen-fen;BAO Ke-chun;CHENG Xiao-dong(Women's Hospital,Zhejiang Universily School of Medicine,Hangzhou 310006 China)

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《中国实用妇科与产科杂志》2022年第7期696-701,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：浙江省子宫恶性肿瘤诊治技术研究中心课题(JBZX-201803)。

摘　　要：特殊病理类型的妊娠滋养细胞肿瘤主要包括胎盘部位滋养细胞肿瘤(placental site trophoblastic tumour,PSTT)和上皮样滋养细胞肿瘤epithelioid trophoblastic tumour(ETT),属于中间型滋养细胞肿瘤。由于缺乏特异性的临床表现和敏感性的肿瘤标志物,诊断过程相对复杂。两者治疗主要以手术治疗为主,病灶局限于子宫时行子宫切除术,有子宫外转移或侵袭时,需同时切除可切除的病灶,根据预后不良因素制定辅助化疗方案。同时由于多数患者为育龄期妇女有保留生育功能的要求,对于病灶局限经过严格筛选的合适患者可以实施保留生育功能的治疗。PSTT和ETT对化疗敏感性均较差,化疗耐药仍然是预后不良的重要因素。由于发病率低,至今缺乏大样本的随机对照试验用于指导临床治疗,新的治疗方法如靶向治疗和免疫治疗等也在不断的探索中。Special pathological types of gestational trophoblastic neoplasia mainly include placental site trophoblastic tumour(PSTT)and epithelioid trophoblastic tumour(ETT),which belong to intermediate-type trophoblastic tumors.The diagnosis is relatively difficult because of the lack of specific clinical manifestations and sensitive tumor markers.Surgery is the mainly primary treatment;hysterectomy is performed for localized disease in uterus and surgical resection can be carried out for resectable lesions if there is extra-uterine invasion or metastasis.The adjuvant chemotherapy plan is made according to the factors of poor prognosis.Most patients are young and have the desire of fertility preservation,the treatment of retaining reproductive function can be implemented for suitable patients with lesion limited to uterus.Due to poor sensitivity of PSTT and ETT to chemotherapy,drug resistance is a most important factor of poor prognosis.There is still a lack of randomized controlled trials to guide clinical treatment because of the low incidence,and new treatments such as targeted therapy amd immunotherapy are also constantly explored.

关 键 词：妊娠滋养细胞肿瘤 胎盘部位滋养细胞肿瘤 上皮样滋养细胞肿瘤 治疗 保留生育功能 

分 类 号：R737.33[医药卫生—肿瘤]