绒癌肺转移并发呼吸衰竭23例临床分析

Clinical management of respiratory failure in the patients of choriocarcinoma with pulmonary metastases

目的:探讨绒癌肺转移并发呼吸衰竭患者临床发病特点、治疗方法和预后影响因素。方法:回顾分析1983年～2010年北京协和医院收治的绒癌肺转移并发急性呼吸衰竭23例患者的临床发病特点、潜在病因、治疗方法、风险因素和结局。结果:本组23例患者中18例(78.3%)伴有肺部感染,11例(47.8%)伴有肺出血,2例胸腔积血,1例肺大泡并气胸。本组23例患者均接受了呼吸支持治疗,其中21例采用以氟尿嘧啶为主或以甲氨蝶呤为主的多药联合方案,平均化疗4.5疗程。21例患者经呼吸支持治疗和化疗后,7例(33.3%)临床完全缓解,2例(9.5%)临床部分缓解,4例(19%)放弃治疗,8例(38.1%)病情进展死亡。其中8例在呼吸衰竭急性发作期间首程采用依托泊苷+放线菌素D或放线菌素D+甲氨蝶呤联合化疗方案,6例(75%)最终临床完全缓解。结论:肺部感染、出血等肺部疾患是引起绒癌肺转移患者发生早期呼吸衰竭的常见原因。绒癌肺转移并发呼吸衰竭患者首程治疗宜采用较温和的抗肿瘤药物和治疗方案。呼吸支持同时积极化疗是治疗绒癌肺转移呼吸衰竭的重要手段。

Objective：To evaluate the clinical characters,treatment,and prognostic factors in choriocarcinoma patients with pulmonary metastases complicated with acute respiratory failure.Method：A total of 23 patients complicated with acute respiratory failure were included in Peking Union Medical College Hospital from 1983 to 2010.We herein carried out a retrospective analysis on clinical characters,potential causes,initial and long-term treatment and risk factors of prognosis in these patients.Result：There are 18 subjects with pulmonary infection,11 with pulmonary hemorrhage,2 with pleural effusion and 1 patient with bulla and pneumothorax.All patients were supported by face mask during acute process of respiratory failure.Some patients received noninvasive ventilation and/or tracheal intubation to support their respiratory.According to anticancer treatment,21 subjects out of 23 patients received multi-drug combined regimen for 4.5 courses of the mean value,mainly including floxuridine or methotrexat.Among a total of 21 patients with respiratory failure who received both chemotherapy and the treatment of respiratory support,complete remission was achieved in 7 cases,partial remission in 2 cases,abandoning treatment in 4 cases,and death was demonstrated in 8 cases.In this group,8 cases were admitted and received with the gentle muti-drug combined regimen by etoposide and actinomycin D,or the schedule of methotrexat and actinomycin D.As a result 6 cases became complete remission.Conclusion：Secondary pulmonary diseases mainly including respiratory infection and hemorrhage contribute to the main pathogen of acute respiratory failure in choriocarcinoma patients with pulmonary metastases.During the acute process of respiratory failure,the gentle multi-drug combined regimen should be treated in the initial schedule.Respiratory support and chemotherapy are feasible and effective techniques in the treatment of respiratory failure in these patients.