动脉栓塞治疗在妊娠滋养细胞肿瘤中的应用进展

Advances in the Aapplication of Arterial Embolization in Management of Gestational Trophoblastic Neoplasia

妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)具有侵袭及破坏周围血管的特性,以血行转移为主,易出现子宫肌层及转移病灶大出血,危及患者生命安全。近年来随着放射介入技术的不断进展,动脉栓塞治疗越来越多地用于GTN,并作为急诊手术的替代方法治疗子宫病灶及转移病灶的出血,同时保留生育功能。GTN中子宫动静脉瘘存在重度出血的风险,彩色多普勒超声是筛查子宫动静脉瘘的首选方法,增强电子计算机断层扫描(CT)和磁共振成像(MRI)也具有较高的特异性,选择性盆腔动脉造影是明确诊断的金标准。良好的插管技术、精准的定位、栓塞剂的合理选用、剂量及速度的控制均不影响卵巢及生育功能,动脉栓塞为GTN患者尽早全身化疗提供时机。综述动脉栓塞治疗在GTN急性大出血和动静脉瘘的应用、栓塞剂的选择、栓塞术后对化疗和生育功能的影响及其并发症。

Gestational trophoblastic neoplasia(GTN)can invade and destroy blood vessels,early appearance of distant blood metastasis,prone to hemorrhage,endangering the life of patients.With the continuous development of radioactive interventional techniques in recent years,arterial embolization therapy is more and more applied in the treatment of GTN.As an alternative to surgical treatment,in the treatment of uterine lesions and metastatic lesions,safe and efficient,the treatment of arterial embolization can preserve the fertility function of women with fertility requirements.There is a risk of chronic or severe bleeding in uterine arteriovenous fistula,color doppler ultrasonography is the preferred screening method for arteriovenous fistula,enhanced computed tomography(CT)and magnetic resonance imaging(MRI)has high specificity,but now selective pelvic arteriography is still the gold standard for diagnosis.Theoretically good intubation technique,accurate positioning,and the reasonable choice of embolization agent,control the embolization agent dose and injection rate can prevent embolization agent into the ovary,will not affect ovarian and reproductive functions.The treatment of arterial embolization will not affect the efficacy of subsequent systemic chemotherapy.Positive and accurate assessment of arterial embolization before treatment,the postoperative attention to the possible complications and active intervention can improve the safety and efficacy of treatment.This artical is to summarize the arterial embolization therapy on the effect of acute bleeding,arteriovenous fistula,the choice of embolic agent,subsequent chemotherapy,fertility and postoperative complications of GTN.