手术治疗妊娠滋养细胞肿瘤的临床分析

Clinical Analysis of Surgical Treatment of Gestational Trophoblastic Neoplasia

目的探讨手术治疗在妊娠滋养细胞肿瘤(Gestational trophoblastic neoplasia,GTN)中的临床价值。方法选择2008年1月1日至2018年12月31日在安徽医科大学附属省立医院接受治疗的GTN患者作为研究对象,收集并回顾性比较分析其临床资料,评估手术治疗在GTN患者中的临床价值。结果低危手术组与高危手术组在前次妊娠类型、术前最大肿瘤直径范围、病灶转移部位、病理类型方面均存在差异(P<0.05)。低危手术组与低危化疗组在患者发病年龄、治疗前HCG水平、分期及预后评分等方面存在差异(P<0.05)。结论患者发病年龄、前次妊娠类型、治疗前HCG水平、术前最大肿瘤直径范围、病灶转移部位、病理类型、FIGO分期及预后评分对手术方式选择具有一定指导价值,当患者出现化疗耐药或复发、子宫持续病灶、转移病灶、难以控制的大出血、子宫病灶较大需缩短病程等时,可根据HCG水平及影像学检查综合评估后选择合适的手术治疗。

Objective To explore the effectiveness of surgery in the treatment of Gestational trophoblastic neoplasia(GTN).Methods GTN patients who were treated in Anhui Provincial Hospital from January 1,2008 to December 31,2018 were selected.Clinical data were collected and retrospectively analyzed to evaluate the clinical value of surgical treatment in GTN patients.Results There were significant differences between the low-risk surgery group and the high-risk surgery group in terms of the type of previous pregnancy,the largest tumor diameter before surgery,the location of tumor metastasis,and the pathological type(P<0.05).There were significant differences between the low-risk surgery group and the low-risk chemotherapy group in terms of age of onset,HCG levels before treatment,staging and prognosis scores(P<0.05).Conclusion The age of onset of the patient,the type of previous pregnancy,the HCG level before treatment,the maximum tumor diameter range before surgery,the location of tumor metastasis,pathological type,FIGO staging and prognostic score have certain guiding value for the selection of surgical treatment.When patients arise symptoms such as chemotherapy resistance,recurrence,persistent uterine lesions,metastasis,uncontrolled vaginal bleeding,or to shorten the course of disease with large uterine lesions,appropriate surgical treatment could be selected according to the comprehensive assessment of HCG level and imaging examination.