子宫切除对治疗滋养细胞肿瘤价值的探讨

The role of hysterectomy in the therapy of gestational trophoblastic tumor

目的评价子宫切除手术在滋养细胞肿瘤治疗中的作用。方法对６８例行子宫切除术的滋养细胞肿瘤病例进行回顾性分析，其中侵蚀性葡萄胎３０例，绒癌３８例。结果２３例因年龄偏大，且无生育要求，术前经短暂化疗后，择期行全子宫切除术，２２例（９５６％）获完全缓解，总平均化疗程数为４２。２７例因产生化疗耐药，且考虑病灶主要局限于子宫，在化疗的同时进行了全子宫切除术，２０例（７４１％）获完全缓解，总平均化疗程数为９４。１８例因子宫穿孔或子宫大出血而急诊进行了全子宫切除术，１７例（９４４％）获完全缓解，总平均化疗程数为７６。结论滋养细胞肿瘤的治疗措施虽然以化疗为主，但子宫切除术在某些选择性病例仍具有十分重要的价值。为使手术彻底，预防复发。

Objective To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. Methods A total of 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985 1997 at PUMC hospital was retrospectively analyzed. Thirty eight cases were diagnosed as choriocarcinoma and 30 as invasive mole. Results Twenty three elder patients who didn′t desire to preserve fertility were selected for hysterectomy after short courses of chemotherapy. Twenty two of them had complete remission (95.6%). The average total course of chemotherapy was 4.2. Of twenty seven chemo refractory cases who were suspected of an isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed. Twenty of them achieved complete remission (74.1%), with an average 9.4 courses of chemotherapy. Emergency hysterectomy was indicated in 18 patients with uterine perforation or life threatening hemorrhage. Seventeen of the emergent cases had complete remission (94.4%), who had received an average 7.6 courses of chemotherapy. Conclusion Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjunct treatment in a selected subset of patients. Modified radical hysterectomy is recommended for the indicated patients.