低危妊娠滋养细胞肿瘤化疗后月经模式的变化及生育结局的随访调查

Follow-up investigation of menstrual pattern changes and reproductive outcomes after chemotherapy for low-risk gestational trophoblastic neoplasia

目的 随访调查低危妊娠滋养细胞肿瘤(LRGTN)化疗后月经模式变化情况及其生育结局。方法 选取2015年8月至2018年8月中国人民解放军空军军医大学第一附属医院收治的132例LRGTN患者,均接受化疗,按照化疗方案,将患者分为Act-D组与EMA/CO组,随访调查患者化疗后月经模式变化及化疗后2年妊娠情况,并对其妊娠结局进行跟踪调查。结果 患者月经来潮大多恢复于第2疗程完成至第3疗程开始前(28.03%)、化疗后6个月内(31.82%)、化疗后第7~12个月(30.30%);患者化疗后大多数(71.97%)出现过月经量减少,月经量正常占23.48%,大部分患者(68.18%)月经周期无变化,周期缩短占22.73%,于化疗后16个月内全部恢复正常;Act-D组月经周期无变化患者比例明显高于EMA/CO组(P <0.05);59例有生育要求,最终31例获得妊娠,其中有25例足月分娩与4例早产儿(均在化疗结束1年后受孕),2例引产(在化疗结束1年内受孕);两组妊娠率及妊娠结局比较差异均无统计学意义(P>0.05)。结论 绝大部分LRGTN患者月经会在化疗后1年内复潮,月经量减少较为常见,EMA/CO化疗较Act-D化疗对患者月经周期影响较大,生育结局均良好。

Objective To follow up and investigate the changes in menstrual pattern and reproductive outcomes after chemotherapy for low-risk gestational trophoblastic neoplasia(LRGTN). Methods A total of 132 LRGTN patients in our hospital were selected and received chemotherapy. According to the chemotherapy regimen, the patients were divided into the Act-D group and the EMA/CO group. The menstrual pattern changes after chemotherapy and the pregnancy status 2 years after chemotherapy were followed up. The outcome was followed up. Results The menstrual onset of patients mostly recovered after the completion of the second course of treatment and before the start of the third course(28.03%), within 6 months after chemotherapy(31.82%), and 7 ~ 12 months after chemotherapy(30.30%). After chemotherapy, most(71.97%)patients had a decrease in menstrual blood volume, 23.48% had normal menstrual blood volume, most(68.18%) had no change in menstrual cycle, and 22.73% had shortened cycle which returned to normal within 16 months after chemotherapy.The proportion of patients without change in menstrual cycle was significantly higher in Act-D group than in EMA/CO group(P < 0.05). 59 patients had the desire of fertility and 31 patients were pregnant, including 25 with full-term delivery, 4 with premature infants(all conceived at 1 year after the end of chemotherapy), and 2 with induced labor(conceived within 1 year after the end of chemotherapy). There was no significant difference in pregnancy rate and pregnancy outcomes between the two groups(P > 0.05). Conclusions Most patients with LRGTN regain menstruation within 1 year after chemotherapy, and menstrual blood volume reduction is more common. EMA/CO chemotherapy has a greater impact on menstrual cycle than Act-D chemotherapy, but the reproductive outcomes are good.