滋养细胞肿瘤脑转移患者行开颅手术后临床及预后分析

Analysis of clinical and prognostic characteristics of patients with brain metastasis of gestational trophoblastic neoplasia after craniotomy

目的探讨接受开颅手术的滋养细胞肿瘤(GTN)脑转移患者的临床特点、治疗方法及预后。方法回顾性分析1990年1月至2018年12月北京协和医院初治的行开颅手术后再接受化疗的22例GTN脑转移患者的临床病例资料。结果 22例GTN脑转移患者接受开颅手术,术后均接受多药联合化疗,81.8%(18/22)患者获完全缓解,18.2%(4/22)获部分缓解。22例患者中除2例患者失访外共有18例存活(90.0%,18/20),2例死亡(10.0%,2/20),5年生存率90.0%。结论 GTN脑转移患者发生颅内病灶出血引起颅内高压甚至脑疝威胁生命时,在保守治疗无效情况下应积极进行开颅手术挽救患者生命,并应在术后辅以及时规范化疗,以提高患者治愈率及生存率。

Objective To investigate the clinical characteristics,management and prognosis of patients with gestational trophoblastic neoplasia(GTN)with brain metastasis after craniotomy.Methods Clinical data of twenty-two GTN patients with brain metastasis who underwent craniotomy and primary chemotherapy in Peking Union Medical College Hospital from Jan.1990 to Dec.2018 were retrospectively analyzed.Results Twenty-two GTN patients with brain metastasis underwent craniotomy,followed by multi-drug chemotherapy in our hospital.81.8%(18/22)patients got complete remission(CR),and 18.2%(4/22)patients got partial remission(PR).Apart from two patients who lost followup,there were 18 patients survived (90.0%,18/20)and 2 patients died(10.0%,2/20).The five-year overall survival rate was 90.0%.Conclusion When intracranial hypertension caused by intracranial hemorrhage occurs in GTN patients with brain metastasis,which endangers the patients’lives,craniotomy should be performed actively to save lives if conservative treatment fails.Timely and standard chemotherapy should be performed postoperatively to improve CR and survival rates.