保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习  

Conservative surgery in stage I placental site trophoblastic tumor:a report of 10 cases and literature review

作　　者：陈金娟[1] 王星然 李文质 程煜[1] 孙艺华 陶祥 马凤华 孙莉 赵洪波[5,6] 鹿欣 CHEN Jinjuan;WANG Xingran;LI Wenzhi;CHENG Yu;SUN Yihua;TAO Xiang;MA Fenghua;SUN Li;ZHAO Hongbo;LU Xin(Department of Gynecology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China;Department of Pathology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China;Department of Radiology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China;Department of Ultrasonography,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China;Department of Obstetrics and Gynecology of Shanghai Medical School of Fudan University,Shanghai 200090,China;Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,Shanghai 200090,China)

机构地区：[1]复旦大学附属妇产科医院妇瘤科,上海200090 [2]复旦大学附属妇产科医院病理科,上海200090 [3]复旦大学附属妇产科医院放射科,上海200090 [4]复旦大学附属妇产科医院超声科,上海200090 [5]复旦大学附属妇产科医院组织库,上海200090 [6]上海市女性生殖内分泌相关疾病重点实验室,上海200090

出　　处：《中国癌症杂志》2023年第9期857-865,共9页China Oncology

摘　　要：背景与目的:胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)是罕见的妇科恶性肿瘤,由于PSTT在子宫内独特的浸润方式和对化疗不敏感特性,全子宫切除是首选的手术方式。本研究旨在探讨Ⅰ期PSTT患者保守手术治疗的可行性和安全性。方法:纳入2015年1月-2021年12月复旦大学附属妇产科医院收治的Ⅰ期PSTT病例,同时分别以“placental site trophoblastic tumor”和“case”、“胎盘部位滋养细胞肿瘤”和“例”为关键词在PubMed和中国知网(CNKI)中检索1990年1月-2021年12月发表的接受保守手术治疗的Ⅰ期PSTT个案报道和系统病例报告,收集患者的临床病理学资料,并进行回顾性分析。结果:共纳入复旦大学附属妇产科医院收治的符合标准的病例10例,中位年龄为27岁,最常见的症状为不规则阴道出血(70.0%),中位诊断距离前次妊娠时间间隔(interval since antecedent pregnancy,ISAP)为14.5个月,中位β-绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-hCG)水平为124.51 mU/mL,病灶直径为0.8~8.0 cm。复旦大学附属妇产科医院收治的10例患者经初始治疗后均获得完全缓解,平均随访时间为48.1个月,均未复发。3例患者治疗后自然受孕,其中2例足月妊娠分娩,1例因计划外妊娠行人工流产。文献复习PSTT病例显示出类似的临床病理学分布特征和疾病转归。结论:保守手术可以作为部分Ⅰ期PSTT患者的一种替代治疗方法,但需更多研究提供证据。Background and purpose:Placental site trophoblastic tumor(PSTT)is a rare type of malignant tumor.Because of its unique mode of invasion in the uterus and its insensitivity to chemotherapy,total hysterectomy is the primary recommendation.The purpose of this study was to investigate the feasibility and safety of conservative surgical treatment in patients with stageⅠPSTT.Methods:The patients with stageⅠPSTT admitted to Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2021 were included,and those published on Pubmed and China National Knowledge Infrastructure(CNKI)from January 1990 to December 2021 were searched with the keywords of“placental site trophoblastic tumor”and“case”,“placental trophoblastic tumor”and“case”respectively.The clinicopathological data of the patients were collected and retrospectively analyzed.Results:A total of 10 cases admitted to Obstetrics and Gynecology Hospital of Fudan University were enrolled.The median age was 27 years.The most common symptom was irregular vaginal bleeding(70.0%).The median time of interval since antecedent pregnancy(ISAP)was 14.5 months.The median level ofβ-human chorionic gonadotrophin(β-hCG)was 124.51 mU/mL,and the diameter of the focus was 0.8-8.0 cm.All 10 patients admitted to Obstetrics and Gynecology Hospital of Fudan University achieved complete remission after initial treatment.The average follow-up time was 48.1 months and there was no recurrence.Three patients became pregnant naturally after treatment,including 2 cases of full-term pregnancy and delivery and 1 case of induced abortion because of unplanned pregnancy.Literature review of PSTT cases showed similar clinicopathological distribution and disease outcome.Conclusion:Conservative surgery could be an alternative choice for selected patients with stageⅠPSTT,but more research is needed to provide evidence.

关 键 词：胎盘部位滋养细胞肿瘤 保守手术 预后 

分 类 号：R737.33[医药卫生—肿瘤]