肺叶切除术治疗滋养细胞肿瘤肺转移的价值

Evaluation of Surgical Resection of Pulmonary Metastasis of Trophoblastic Tumour

目的评价肺叶切除术在滋养细胞肿瘤肺转移治疗中的作用。方法对45例行肺叶切除术的滋养细胞肿瘤病例进行回顾性分析,其中侵袭性葡萄胎7例,绒癌38例。结果45例患者经过一定疗程的化疗后,均进行了肺叶切除术。7例侵袭性葡萄胎患者完全缓解。绒癌Ⅲa期患者11例,平均化疗13个疗程,10例完全缓解,1例部分缓解;Ⅲb期患者17例,平均化疗14.3个疗程,11例完全缓解,3例部分缓解,3例肿瘤进展死亡;Ⅳ期患者10例,平均化疗15个疗程,6例完全缓解,4例肿瘤进展死亡。45份手术切除病理标本中,27例为出血坏死组织,其中17例患者完全缓解(63%),4例部分缓解,6例肿瘤进展死亡。16例病灶周围有纤维化,其中14例完全缓解(88%),2例部分缓解。2例病理结果为结核。结论滋养细胞肿瘤的治疗措施虽然以化疗为主,但是肺叶切除术对某些选择性病例仍是必要而且有效的治疗手段。病理结果对预后的判断具有一定的指导意义。

To evaluate the role of lung lobectomy in the patients of tumor with lung metastases.Methods A total of45cases of trophoblastic tumor with pulmonary metastases treated by lung lobectomy from1985～2002at PUMC hospital was retrospectively analyzed.Seven cases were diagnosed as invasive mole and thirty-eight as choriocarcinoma.Results Lung lobectomy was performed in all of these patients after several courses of chemotherapy.Seven cases of invasive mole reached complete remission.Eleven cases of choriocarcinoma with stageⅢa had received average13courses of chemotherapy,10of them reached complete remission.Seventeen cases of choriocarcinoma with stageⅢb had received average14.3courses of chemotherapy,11of them reached complete remission.Ten cases of choriocarcinoma with stageⅣhad received average15courses of chemotherapy,six of them reached complete remission.In the45patients,histologic examination disclosed haemorrhagic necrotic tissue in27patients,17of them reached complete remission(63%).Histologic examination also revealed fibrosis around the focus in16patients,14of them reached complete remission(88%).Tuberculosis was found in2patients.Conclusions Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor,lung lobectomy remains an important adjunct treatment in a selected subset of patients.Pathological examinations can help to estimate the prognosis.