【摘要】 目的探讨经子宫动脉化疗栓塞治疗难治性妊娠滋养细胞肿瘤及肿瘤出血的疗效。方法妊娠滋养细胞肿瘤24例,其中侵蚀性葡萄胎13例,绒毛膜癌11例,平均年龄(28.12±2.23)岁。Seldinger技术行双侧子宫动脉超选择性插管,给予肿瘤供血动脉内灌注化疗药物后,透视监视下低压流控注入聚乙烯醇颗粒(PVA)或明胶海绵颗粒(GF)栓塞,定期复查并随访。结果侵蚀性葡萄胎及绒毛膜癌数字减影血管造影(DSA)表现基本类同。动脉期肿瘤内血管明显增多、迂曲、紊乱,形态不一,成团状或丛状。7例侵蚀性葡萄胎,1例绒毛膜癌DSA造影显示明显的动静脉瘘,静脉早显。实质期肿瘤组织呈圆形或半圆形染色。24例经1～3次介入治疗后阴道出血3 d左右停止,治疗后1周血绒毛膜促性腺激素开始下降,4～16周降至正常范围。B超检查显示子宫逐渐恢复至正常大小。结论超选择性子宫动脉化疗栓塞治疗妊娠滋养细胞肿瘤疗效确切,不良反应少,尤其对原发灶或转移所致的出血和难治性病例的处理有独到之处,值得推广应用。更多还原

【Abstract】 Objective To study the clinical efficacy and safety of super-selective transcatheter uterine arterial chemo-embolization in the treatment of intractable gestational trophoblastic tumors and tumor-related hemorrhage.Methods 24 cases,confirmed as gestational trophoblastic tumors(13 cases with invasive moles,and 11 cases with chorio-carcinomas;mean age 28.12±2.23 years),were treated with super-selective trans-catheter uterine arterial chemo-embolization using the Seldinger technique.The PVA or GF particles were injected by controlled low-pressure under fluoroscopy.The patients were followed up.Results The angiography of invasive mole and choriocarcinoma showed some similar signs.The tumor vessel density was abnormally increased and circuitously in the artery phase.Obvious A-V fistula could be observed in 7/13 invasive moles and 1/11 choriocarcinomas.Circle or semicircle tumor staining could be noticed in the parenchymal phase.Vaginal bleeding in all cases disappeared within 3 days and blood HCG began to lower at 1 w/k and reached the normal level between 4-16 w/k.The enlarged uterus was gradually restored to normal after 1-3 procedures.Conclusion Super-selective trans-catheter uterine arterial chemo-embolization in the treatment of gestational trophoblastic tumor demonstrates satisfying efficacy and safety.It shows unique advantages in intractable cases,primary or metastasis tumor-related hemorrhage and should be widely introduced.更多还原