妊娠滋养细胞肿瘤阴道转移13例临床分析

Clinical analysis of vaginal metastasis of gestational trophoblastic tumor in 13 cases

目的评估妊娠滋养细胞肿瘤阴道转移患者的临床表现、治疗方法及疗效。方法选择1991年8月~2015年8月我院妇科收治的13例妊娠滋养细胞肿瘤阴道转移患者临床资料进行研究。结果侵蚀性葡萄胎和绒毛膜癌阴道转移的发生率分别为8.9%和8.2%,其中7例发生破溃大出血。治疗方法采用以5-FU为主的联合化疗或EMA-CO方案化疗,7例大出血患者进行阴道填塞,另3例大出血患者因填塞效果差行选择性动脉栓塞术。13例中12例经1~8个疗程的化疗后,获得完全缓解,经定期随访,无复发迹象,1例合并脑转移化疗期间因耐药病情恶化死亡。结论以5-FU为主的联合化疗、局部注射5-FU是治疗妊娠滋养细胞肿瘤阴道转移的有效方法。选择性盆腔动脉栓塞术对于难以控制的转移结节大出血具有重要的临床治疗价值。

Objective To evaluate the clinical manifestation, treatment and efficacy of gestational trophoblastic cancer patients with vaginal metastases. Methods The clinical data of 13 gestational trophoblastic cancer patients with vaginal metastases admitted in our hospital from August 1991 to August 2015 were analyzed. Results The incidence of vaginal metastasis in invasive hydafidiform mole and choriocarcinoma was 8.9% and 8.2%, respectively, of which 7 cases had ulceration hemorrhage. 5-FU-based combination chemotherapy or EMA-CO chemotherapy were used as treatment methods. 7 patients with massive bleeding were treated with vaginal tamponade. Another 3 cases of massive bleeding underwent selective arterial embolization due to the poor effect of tamponade. 12 of 13 cases got complete remission af- ter 1 to 8 courses of chemotherapy, and had nO signs of recurrence after regular follow-up.1 case with brain metastases during chemotherapy died due to drug resistance and the condition deterioration. Conclusion 5-FU-based combination chemotherapy with local injection of 5-FU is an effective method for the treatment of vaginal metastasis of gestational trophoblastic tumor. Selective pelvic arterial embolizafion has an important clinical value for uncontrolled metastatic nodular hemorrhage.