【作者】 冯华； 冯秋红； 马俊英；

【Author】 Feng Hua Feng Qiu-Hong Ma Jun-Ying Department of Obsterics and Gynecology, the fourth hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院妇产科；

【摘要】 目的:分析滋养细胞肿瘤的临床特点及应用化疗为主的综合治疗后的临床转归,观察化疗中的毒副作用。方法: 收集2001年12月至2005年10月住院治疗的滋养细胞肿瘤患者36例,其中经产妇30例,侵蚀性葡萄胎10例,绒癌26例。按照FIGO标准分期:I期19例,Ⅱ期2例,Ⅲa期9例,Ⅲ b期5例,Ⅲc期1例。26例绒癌患者中,末次妊娠为葡萄胎者2例,流产后11例,足月产后13例(其中2例分别为产后 18年和产后1年,表现为月经不规则和经量多数月,根据妇科检查,入院诊断分别为子宫颈癌和子宫粘膜下肌瘤,经局部活检病理报告为绒癌)。32例患者应用EMA—CO方案190 个疗程,其中4例治疗过程中血HCG下降缓慢,后改为PVB 方案共8疗程,4例患者应用EMA方案20个疗程。28例患者单纯用化疗方法,其中2例在宫颈和阴道有单发转移病灶结节,加用了5-Fu250毫克病灶局部注射,治疗两次后结节消失。另外8例患者化疗分别进行了2—7个疗程后,血HCG 下降迟缓,于是追加了手术治疗,行次广泛子宫切除术,术后病理证实为绒癌,并继续化疗后血HCG很快降至正常。全部病例血HCG达到正常,且临床症状、体征消失后再巩固化疗1-2个疗程,为近期临床治愈。结果:28例患者经过3-10 个疗程治疗后达到近期临床治愈,平均需用4．14个疗程。其中I期和Ⅱ期患者平均3．5个疗程,化疗加手术的患者平均用了5．25个疗程。随访至今已6—42个月无1例复发。本文化疗总共作了218个疗程,有67个疗程出现白细胞减少,其中Ⅲ度减少有6个疗程。应用粒细胞集落刺激因子后白细胞升至正常继续化疗,有118个疗程出现了消化道反应,I、Ⅱ、Ⅲ度反应分别为82、32、4个疗程,给予止吐药物后继续化疗,有3个疗程出现腹泻,每日排便未超过5次,便常规正常, 对症处理后腹泻停止。有10个疗程出现肝功能异常,1个疗程出现发热,分别给予保肝治疗和抗炎治疗。肝功能和体温恢复正常后化疗继续进行。结论:滋养细胞肿瘤对化疗敏感, 且期别越早疗效越好。既使已有转移多数病例仍可治愈。在化疗过程中,如果HCG下降不满意时,要及时更换治疗方案或采取手术治疗,以缩短化疗次数,避免产生耐药。对以转移灶症状出现的患者,要警惕滋养细胞肿瘤的存在,及时确诊和治疗。更多还原

【Abstract】 Objective: To analysis the clinical characteristics of trophoblastic tumor, the prognosis by combination chemotherapy adding synthesized treatment and sized efficacy. Methods: From December 2001 to October 2005,36 cases of trophoblastic tumor were treated with. Among them, puerperant female was 30 cases, invasive mole was10 cases and choriocarcinoma was 26 cases. According to FIGO standard, I stage was 19 cases, II stage was 2 cases, III a stage was 9 cases, III b stage was 5 cases, and IIIC stage was 1 case, last gravidity were hydatitlform mole 2 cases, following abortion 11 cases, and term pregancy 13 cases. 32 cases were treated with EMA-CO regimen 190 courses,among them , 4 cases changed PVB regimen for 8 courses due to HCG value reduced slowly. Another 4 cases were treated with EMA regimen for 20 courses. 28 cases were treated only with chemotherapy, 2 cases had metastasized to vagina and cervix, added 5-Fu 250mg injecting to location. After injection 2 doses, the metastasized oven had disappeared. 8 cases were treated with chemotherapy adding operation due to HCG desentling sluggishly. When whole patients’ HCG reached normal and clinical symptoms and signs vanished, they received 1-2 courses again to consolidate effection. It was considered clinical immediately complete remission. Results : 28 cases reached cure processing 3-10 courses, the median number of courses were 4.14, I and II stage patients needed 3.5 courses,and the patients that needed chemotherapy adding operation used 5.25 courses. They were followed up for 6-42 months. Among 218 courses ,there were 67 courses emerging myelosupperssion, 118 courses had appeared digestive reaction. Hepatic injury emerged in 10 courses. Conclusion: Trophoblastic tumor is sensitive to chemotherapy. It is more effective when disease is early stage. If HCG descents slowly, the operation or changing regimen is considarded to diminish chemotherapy courses and to avoid durg-resistant When some patients show metastasized symptoms, it is important to diagnosis in time.更多还原