化疗治疗妊娠滋养细胞肿瘤72例近远期疗效观察

Observation on short and long term curative effects of chemotherapy on 72 cases of gestational trophoblastic neoplasia

目的探讨化疗治疗妊娠滋养细胞肿瘤（GTN）的近远期疗效。方法选择2009年6月~2013年2月72例GTN患者,均采用化疗治疗,观察近远期治疗效果。结果Ⅰ期患者化疗后,治疗有效率为100.00%;Ⅱ期患者化疗后,侵蚀性葡萄胎有效率100.00%,绒癌为88.89%;Ⅲ期患者化疗后,侵蚀性葡萄胎有效率为95.24%,绒癌为95.00%。化疗对GTN整体有效率为95.83%。化疗中较常见的毒副反应为脱发、骨髓抑制、肝功能损害、恶心呕吐等。59例定期随访6~76个月,13例失访。完全缓解（CR）患者中,3例复发（5.88%）;部分缓解（PR）患者中,1例复发（14.29%）。3例血β-h CG正常后带瘤出院患者中,1例为颅内带瘤出院,2例为肺部带瘤出院。3例定期随访18~56个月,其中颅内带瘤出院患者CT检查提示为钙化灶;2例肺部带瘤出院患者中,1例在随访期间肺部转移病灶没有明显的变化,1例转移灶缩小。10例停药后共12例次妊娠;胚胎停育2例次,宫外孕1例次,葡萄胎1例次;宫内引产2例次,4例次足月产,正常分娩胎儿未见明显异常。结论化疗治疗妊娠滋养细胞具有较好的近远期疗效;对于有生育计划的患者,要至少在停药1年后妊娠,并加强产检。

Objective To explore the short and long term curative effects of chemotherapy on gestational trophoblastic neoplasia（GTN）. Methods 72 cases of GTN visiting the hospital between June 2009 and February 2013 were selected and received the chemotherapy. The short and long term curative effects were observed. Results After the chemotherapy, the effective rate of the patient in stageⅠwas 100%; for the patients in stageⅡ, the effective rates for invasive mole and chorio carcinoma were 100.00% and88.89%, respectively; for the patients in stage Ⅲ, the effective rates for invasive mole and chorio carcinoma were 95.24% and95.00%, respectively. The total effective rate of chemotherapy on GTN was 95.83%.The common adverse reactions were alopecia,bone marrow suppression, liver damage, and nausea and vomiting, etc. Follow-up was carried out in 59 patients for 6 to 76 months,and 13 patients were lost for the follow-up. Among the cases of complete remission, there were 3 cases of recurrence（5.88%）. Among the cases of partial remission, there was one case of recurrence（14.29%）. Among the 3 discharged tumor cases with normal β-h CG,there were 1 cases of tumor in brain and 2 of tumor in lung. Regular follow-up was carried out in 3 patients for 18 to 56 months. CT scans revealed calcification in the discharged patient with tumor in brain. As to the 2 discharged patients with tumor in lung, 1patient had no obviously changes in the metastatic lesion during the follow-up, and the metastasis became smaller in the other one. 10 patients got 12 cases of gestation after drug withdrawal, in which there were 2 cases of embryo damage, 1 case of ectopic pregnancy, 1case of vesicular mole, 2 cases of intrauterine induction delivery, and 4 cases of term birth. Conclusion Chemotherapy has good short and long term curative effects on gestational trophoblastic neoplasia. Patients with procreation plans should take pregnancy at least 1year after the drug withdrawal and strengthen the antenatal care.