【摘要】 目的探讨低危型妊娠滋养细胞肿瘤耐药的相关高危因素。方法收集2000年1月至2010年1月浙江大学附属妇产科医院收治的452例低危型妊娠滋养细胞肿瘤患者的资料,根据耐药与否分为耐药组(86例)和非耐药组(366例)进行回顾性分析。结果耐药发生率为19.03%。初始化疗前高HCG值(尤其是血HCG值>10000U/L)者、肺部有多处转移灶、有远处转移、子宫大病灶者易发生耐药。绒癌较侵蚀性葡萄胎易发生耐药。另外化疗副反应大、对化疗药物敏感导致疗程和剂量不足、疗程间隔过长的也易产生耐药。而年龄、临床分期、先期妊娠性质、化疗药物及给药途径、初次化疗至末次妊娠终止的间隔时间方面两组比较差异无统计学意义(P>0.05)。结论化疗方案应个体化,对耐药的高危人群应及早合理联合用药,重视结合手术等综合治疗,可降低耐药率,提高治愈率。更多还原

【Abstract】 Objective To investigate the related high-risk factors of drug resistance in low-risk gestational trophoblastic neoplasia(GTN) .Methods 452 cases of low-risk GTN patients admitted in Women’s Hospital of Zhejiang University between Jan 2000 and Jan 2010 were analyzed retrospectively.According to drug resistance or not,they are divided into drug resistant group(86 cases) and non-drug resistant group(366 cases) .Results The incidence of drug resistance is 19.03%.High serous hCG level before initial chemotherapy(especially greater than 10 000 U/L) ,lung metastases in several places,distant metastasis,large lesion in uterine are apt to develop drug resistance;Drug resistance happens in choriocarcinomas more easily than invasive hydatidiform moles;In addition,serious side effects of chemotherapy,insufficient course and dose of treatment for sensitive to chemotherapy drugs,long interval time between two courses are also prone to be resistant.However,there are no difference in age,clinical stages,previous pregnancy properties,chemotherapy drugs and the way to administration,interval time between last pregnancy and initial chemotherapy(P>0.05) .Conclusion Chemotherapy regimens should be individualized.Combined drugs should to be administered reasonably to high-risk group as early as possible.Also,we should pay attention to comprehensive treatment such as surgery.Only in this way,we can reduce the rate of drug resistance and improve the curative effect.更多还原