恶性滋养细胞肿瘤25例临床分析

Clinical Analysis of 25 Cases of Malignant Trophoblastic Tumor

目的总结恶性滋养细胞肿瘤的诊治经验,以减少临床上的误诊误治,提高恶性滋养细胞肿瘤的治愈率。方法回顾性分析连云港市第一人民医院妇产科1998年1月至2007年7月共收治的25例恶性滋养细胞肿瘤的临床资料。结果侵袭性葡萄胎17例,绒毛膜癌8例,根据病史、血β-HCG、影像学资料、病理及脑脊液等检查确诊。Ⅰ期侵袭性葡萄胎5例、Ⅱ期3例,Ⅲ期7例,Ⅳ期2例,发生脑转移1例。绒癌Ⅰ期2例,Ⅱ期1例,Ⅲ期4例,Ⅳ期1例发生脑转移。25例治疗均以化疗为主,其中单纯化疗者18例,化疗+手术治疗者5例,化疗+放疗2例。侵蚀性葡萄胎治愈率为82.3%,1例因Ⅳ度骨髓抑制死亡,1例治疗后复发。绒毛膜癌治愈率为87.4%,1例好转。结论临床上病史与血β-HCG有机结合,可使恶性滋养细胞肿瘤得以早期诊治,早期病例化疗可以将其治愈,对于晚期患者综合治疗可进一步提高治愈率和改善生活质量。

Objective To summarize the experiences of diagnosis and treatment of malignant trophoblastic tumors in order to reduce the clinical misdiagnosis or mistreatment and increase the cure rate of malignant trophoblastic tumors. Methods To analyze the clinical data of 25 cases of malignant tropboblastic tumors in our department from January 1998 to July 2007 retrospectively. Results 17 cases of invasive mole, 8 cases of horiocarcinoma. According to medical history, serum β-HCG examing, image data, pathology and cerebrospinal fluid, the diagnosis of malignant trophoblastic tumors can be confirmed. 5 cases ofinvasive mole in stage Ⅰ, Ⅱ stage of 3 cases, m stage of 7 cases, Ⅳ stage of 2 cases, Cerebral metastasis in 1 case. 8 cases were Choriocarcinoma. 2 cases of stage Ⅰ, 1 case of stage Ⅱ,4 cases of stage Ⅲ, 1 case of stage Ⅳ which was founded cerebral metastasis. 25 cases are treated mainly with chemotherapy, in which chemotherapy alone were in 18 cases, chemotherapy and surgery in 5 cases, chemotherapy and radiotherapy in 2 cases. lnvasive mole cure rate was 82.3%, 1 patient died due to stage IV myelosuppression, 1 patient relapsed after treatment. Cure rate of Choriocarcinoma was g7.4%, and Ⅰ case was improved. Conclusion The diagnosis of malignant trophoblastic tumor can be early made by the organic combination of clinical history and serum β-HCG, early cases can be cured with chemotherapy .For some patients with advanced diseases integrated treatment can further improve the cure rate and improve the quality of life.