Uterine epithelioid trophoblastic tumor with the main manifestation of increased human chorionic gonadotropin:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.

Epithelioid trophoblastic tumor of the lower uterine segment and cervical canal:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations,possible causes, and related influencing factors.CASE SUMMARY A 35-year-old woman(gravida 7, miscarriage 3, induction 2 with 1 being twins,para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made.Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue.Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.

THE ROLE OF HYSTERECTOMY IN THE THERAPY OF GESTATIONAL TROPHOBLASTIC TUMOR

To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. [WT5”BX]Methods.[WT5”BZ]We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty eight cases were diagnosed of choriocarcinoma and 30 were invasive mole. [WT5”BX]Results.[WT5”BZ]Twenty three elder patients who didn’t desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95 6%), the total aver age courses of chemotherapy was 4 2. Of twenty seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74 1%), the total average courses of chemotherapy were 9 4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life threatening hemorrhage, 17 cases had a complete remission(94 4%), the total average courses of chemotherapy were 7 6. [WT5”BX]Conclusion.[WT5”BZ]Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it’s better to perform extended hysterectomy for the indicated patients.

DIAGNOSIS AND TREATMENT OF THE MALIGNANT GESTATIONAL TROPHOBLASTIC TUMOR WITH PULMONARY METASTASIS COMPLICATED WITH PULMONARY TUBERCULOSIS

Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tuberculosis in our hospital from 1980 to 1997 retrospectively. Results.From the x ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the chemotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three cases. All of the patients were treated with multiagent chemotherapy. Seven patients achiceved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1 woman who had achieved a complete remission from MGTT for 14 months died of miliary tuberculosis. Conclusion. It is very important to make differential diagnosis of the MGTT with pulmonary metastasis complicated with pulmonary tuberculosis. Trying to avoid excessive anti tumor treatment owing to mistake pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti tuberculosis treatment because of missed diagnosis should be emphasized.

EMA/CO Regimen Chemotherapy for Gestational Trophoblastic Tumor

Objective To evaluate the efficacy and safety of etoposide, methotrexate, actinomycin D, vincristine and cyclophosphamide (EMA/CO) therapy for gestational trophoblastic tumor (GTT). Methods Medical records of all patients with low risk, middle risk and high risk GTT receiving EMA/CO regimen chemotherapy were analyzed retrospectively. Results\ Twenty one low risk and fourteen middle risk GTT received EMA/CO with 100% remission, six patients with high risk GTT received EMA/CO with 83% complete response and with 17% partial response; Gastrointestinal, hematologic and hepatic toxicity, as well as shed of hair is predictable, mild and reversible. Conclusion\ At present EMA/CO chemotherapy is the choice of our treatment for patients with high, middle and low risk GTT.\;

Special epithelioid trophoblastic tumor:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT)is a special type of gestational trophoblastic tumor.However,its pathogenesis has been incompletely elucidated.ETT rarely occurs in the ovaries and fallopian tubes,unlike placental site trophoblastic tumor,requiring a histopathological biopsy and immunohistochemistry for further diagnosis.CASE SUMMARY A 29-year-old woman with irregular vaginal bleeding and elevated serum chorionic gonadotropin(β-hCG)levels presented similar symptoms to ectopic pregnancy.Transvaginal ultrasound revealed abnormal echoes of the left adnexa.Postoperatively,the pathology of the left ovary and fallopian tube was reported as ETT.The patient was followed up with regular hCG measurements and ultrasounds.The blood hCG values showed an upward trend 3 mo after the operation and then chemotherapy was prescribed.The current health status is normal.CONCLUSION For women of childbearing age with elevated serumβ-hCG levels,practitioners should consider ETT and be alert to the poor prognosis of the disease.After surgery,the patient’s condition should be closely observed to prevent recurrence and metastasis.Postoperative chemotherapy is only helpful for treating the disease to a certain extent.

Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging

Objective: The purpose of this study was to review clinical data of metastasia lesion of gestation trophoblastic tumor (GTT) in abdominopelvic cavity by color Doppler ultrasound. Subjects and Methods: A retrospective analysis of 13 cases of GTT in China was performed. Clinical appearances, serum human chorionic gonadotropin (hCG) levels, sonographic findings, Doppler waveforms, and patient outcomes were followed up. Color Doppler ultrasound was performed to diagnose the presence of GTT, detect metastasia lesion in abdominopelvic cavity, assess disease recurrence, and monitor the efficacy of chemotherapy. Results: Of the 13 patients with GTT, 4 had choriocarcinoma which 3 cases occurred after an abortion, 1 after a year of dilation and suction evacuation for the hydatidform mole. Metastasia lesion in abdominopelvic cavity was detected by color Doppler ultrasound in all cases of choriocarcinoma, among which the metastasia lesion were found at uterine fundus, near uterus, colon and cystic vascular space near the uterus, repectively. 9 cases with an invasive hydatidiforn mole (IHM) occurred after one to three months of dilation and suction evacuation for the hydatidform mole, consistant with the hCG levels markedly elevating. Metastasia lesion in abdominopelvic cavity was also detected by color Doppler ultrasound besides invasive lesion in uterine muscular layer in all cases of IHM, among which 3 cases showed metastasia lesion in cystic vascular space near the uterus, 2 cases were detected in side wall of pelvic cavity, while the rest were found in abdominal cavity, right kidney, colon and near uterus, respectively. Meanwhile, the image of metastasia lesion with IHM was similar to choriocarcinoma’s. And the reticular structure, the cystic vascular space and solid lesion may be showed by ultrasound. The metastasia lesion had abundant flow. Doppler waveforms showed resistive indices of 0.34 (SD 0.07) for metastasia lesion. There was the same lower-impedance as invasive lesion in uterine muscular layer. Except an IHM with the renal metastasia lesion having been followed, abnormal sonographic and Doppler findings in other metastasia disease all disappeared after surgical operation or chemotherapy were successful. Conclusions: Sonography and Doppler imaging were helpful in detecting metastasia lesion in abdominopelvic cavity, and in following the effectiveness of chemotherapy. And it should be taken full examination for GTT by Color Doppler ultrasound in order to avoid mistake.

Evaluation of surgical resection of pulmonary metastasis of trophoblastic tumor

Objective: To evaluate the role of the lung lobectomy in gestational trophoblastic tumor patients with lung metastases. Methods: A total of 45 cases of trophoblastic tumor with pulmonary metastases treated by lung lobectomy from 1985~2002 at PUMC hospital were 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 stage Ⅲa had received average 13 courses of chemotherapy, 10 of them reached complete remission. Seventeen cases of choriocarcinoma with stage Ⅲb had received average 14.3 courses of chemotherapy, 11 of them reached complete remission. Ten cases of choriocarcinoma with stage Ⅳ had received average 15 courses of chemotherapy, six of them reached complete remission. In the 45 patients, histologic examination disclosed haemorrhagic necrotic tissue in 27 patients, 17 of them reached complete remission(63%). Histologic examination also revealed fibrosis around the focus in 16 patients, 14 of them reached complete remission(88%). Tuberculosis was found in 2 patients.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.

Possible link between congenital uterine malformations and epitheliod trophoblastic tumor

Background: Epitheloid trophoblast tumor (ETT) is a tenuous type of gestational trophoblastic disease. Although clinically ETT behave in variable fashion, it is considered as a potentially malignant tumor, fatal malignancy occurs in 10% of the cases. Case and Conclusion: A 41 years old patient, who previously underwent Tompkins operation because of congenital uterine septum was admitted to our clinic due to irregular bleeding. Despite of serum hCG levels under the upper limit of normal, histopathology analysis of D&C obtained endometrial samples confirmed the presence of ETT by immunostainings. Henceforth we performed prompt abdominal hysterectomy and preserved the normal structured ovaries. According to the müllerianosis theory of endometriosis aberrant differentiation or migration could cause spreading of cells throughout the fetal organogenesis of the uterus. These cells in an apoptosis week environment might correlate with the initiation of ETT. As a conclusion we suggest further studies to assess the link between ectopic cells and ETT, to gain a better understanding in the pathomechanism of the tumor.

A rare cause for gestational trophoblastic neoplasia: Placental site trophoblastic tumor

Placental site trophoblastic tumor is a rare sub-group of gestational trophoblastic neoplasia. There is a wide clinical spectrum of presentation and behaviour ranging from a benign condition to an aggressive disease with a fatal outcome. We report a case of placental site trophoblastic tumor in 23-year-old women with irregular vaginal bleeding during postpartum lactation period. In addition to persistent low level β-hCG titers, ultrasound examination revealed a suspicious low-echoic area in the myometrium consistent with gestational trophoblastic disease. After histopathological examination of the specimen achieved by ultrasound-guided dilatation and curettage of the uterus, the placental site trophoblastic tumor diagnosis was made and subsequently total abdominal hysterectomy was performed. The patient had an uneventful recovery, and no recurrence was detected for 40 months in the follow-up period.

宫角异位型侵袭性葡萄胎一例

本文报道了一例异位侵袭性葡萄胎患者的临床特征、诊断过程及治疗方案。其人绒毛膜促性腺激素(β-HCG)提示24335 m IU/mL、超声提示左侧附件区异常回声(不除外滋养细胞疾病)及病检示(宫内组织)分泌期样宫内膜,左输卵管及左宫角、左阔韧带病灶查见水肿的绒毛组织并伴有滋养叶细胞增生,多系葡萄胎;免疫组化提示p53(+)、p57(-)、HCG(+),人胎盘碱性磷酸酶(PLAP)(-)、Ki-67(高表达),组织学类型符合完全性葡萄胎,CD34及弹力纤维染色提示一处血管内查见绒毛组织,符合侵袭性葡萄胎改变,确诊为侵袭性葡萄胎。治疗上采用了以手术为主、辅助化疗的综合治疗策略。

人源胎盘部位滋养细胞肿瘤类器官模型的构建与鉴定

目的构建并鉴定人源胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)的类器官模型。方法选取PSTT组织进行消化和分离,得到肿瘤细胞后进行基质胶包埋,利用特定的类器官培养基进行培养。HE染色观察类器官模型的组织学形态,通过免疫组化和免疫荧光染色分析中间型滋养细胞标志物人胎盘催乳素(human placental prolactin,HPL)、人类白细胞抗原-G(human leukocyte antigen-G,HLA-G)和胎盘碱性磷酸酶(placental alkaline phosphatase,PLAP)的表达,鉴定构建的PSTT类器官模型与PSTT组织之间的一致性。同时对构建的模型进行传代及冻存、复苏,显微镜下分析其生长形态与速度,探讨其作为类器官模型在PSTT基础及临床转化研究应用的可能性。结果构建的类器官模型可稳定增殖并传代,可见其从小微球状态长成紧致实性球体或带有滤泡样结构的球体,约7~10天可长满并传代,冻存及复苏后细胞状态稳定;经HE染色发现类器官中细胞形态与PSTT原代肿瘤细胞相似;免疫组化与免疫荧光染色鉴定结果显示,PSTT类器官组织高表达中间型滋养细胞的标志分子HPL、HLA-G和PALP,提示构建的类器官模型主要包含中间型滋养细胞。结论成功建立了人源PSTT类器官(adult-derived PSTT organoid,ADPO)模型并进行鉴定。

胎盘部位滋养细胞肿瘤的临床病理诊断及一例误诊误治分析

随着我国生育政策的推进,医疗卫生部门及各级医院对于孕产妇及胎儿健康的关注程度随之加强。当前,婚检、唐氏筛查、大排畸等各种孕检、产检虽已基本普及,但仍有部分较为少见的围生期疾病初期症状不明显,且无较多临床影像学资料参考,导致误诊、漏诊,延误病情,如胎盘部位滋养细胞肿瘤(PSTT)。该疾病鲜少有文献资料研究,且临床表现无特殊性,为增进妇产科、肿瘤科临床相关医学从业者对此疾病的认知,提高诊治效率、准确度,本文报告了1例误诊、误治PSTT患者情况,分析讨论了PSTT的发病机制、临床特点、影像学表现、实验室检查和病理诊断标准、鉴别诊断要点、治疗和预后以及误诊原因,以期增加临床医生对该病的了解,提高警惕,防止误诊、误疗。

Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases.The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics(FIGO)2000 criteria: four or more plateaued human chorionic gonadotropin(hCG)concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However,the latter reason for treatment is no longer used by many centers. In addition,GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate(MTX) or Actinomycin-D(Act-D), can cure about 70% of patients with FIGO/World Health Organization(WHO) prognosis risk score ≤ 6(low risk), reserving multiple agent chemotherapy, such as EMA/CO(Etoposide,MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7(high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death,allow the healing and maintenance of the reproductive potential of these women.

Expression of c-erbB2 in Gestational Trophoblastic Disease and Its Clinical Significance

Summary: In order to explore a potential indicator of predicting the occurrence and development of gestational trophoblastic tumor, the expression of c-erbB2 oncogene in human normal placenta, hydatidiform mole and choriocarcinoma was investigated. The expression of c-erbB2 was detected immunohistochemically by monoclonal antibody against the gene on the formalin-fixed paraffin sections of 21 hydatidiform moles, 21 invasive moles, 20 choriocarcinomas and 30 normal placentas. Results showed that the expression level of c-erbB2 was significantly higher in gestational trophoblastic tumor than in hydatidiform mole and normal placenta of midterm and term pregnancy (P<0.05), while there was no significant difference between patients with gestational trophoblastic tumor of stage Ⅲ, Ⅳ and those of stage Ⅰ, Ⅱ. It was demonstrated that overexpression of c-erbB2 may closely associated with malignant transformation of hydatidiform mole, not only providing important insight into pathogenesis of gestational trophoblastic tumor, but also having an important significance for the early diagnosis and early treatment of gestational trophoblastic tumor.

胸部CT平扫在妊娠滋养细胞肿瘤肺转移的诊断价值

目的 探讨胸部CT平扫在妊娠滋养细胞肿瘤肺转移的诊断价值,旨在为临床工作提供有借鉴作用的信息。方法 将2015年5月至2019年5月在佳木斯大学宏大医院收治的Ⅲ期妊娠滋养细胞肿瘤患者(n=90)纳入研究,所有患者均给予胸部X线和肺部CT检查,探讨胸部CT扫描在初诊时诊断GTN肺转移的价值、其与初治结果 之间的关系以及其在随访中的作用,分析患者的治疗情况。结果 90例患者中,37例确诊为肺转移,其中27例为低危患者,10例为高危患者;高危患者与低危患者的真阳性率比较(50.00%>38.57%),P>0.05。经胸部CT扫描检查并确诊为肺转移患者的血清hCG水平为[(17450.73±120.43)U/L],37例确诊患者中,双肺病变14例,以中下肺为多,达12例;单肺病变以右肺为多,13例,左肺10例,37例中有12例为胸膜下结节。低危患者治疗后的缓解率(89.39%)比高危患者要高(70.83%),P<0.05。结论 胸部CT平扫在妊娠滋养细胞肿瘤肺转移可提高肺转移的阳性率,对患者应尽量做胸部CT平扫检查,可见临床诊断价值较高。

保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习

背景与目的:胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)是罕见的妇科恶性肿瘤,由于PSTT在子宫内独特的浸润方式和对化疗不敏感特性,全子宫切除是首选的手术方式。本研究旨在探讨Ⅰ期PSTT患者保守手术治疗的可行性和安全性。方法:纳入2015年1月-2021年12月复旦大学附属妇产科医院收治的Ⅰ期PSTT病例,同时分别以“placental site trophoblastic tumor”和“case”、“胎盘部位滋养细胞肿瘤”和“例”为关键词在PubMed和中国知网(CNKI)中检索1990年1月-2021年12月发表的接受保守手术治疗的Ⅰ期PSTT个案报道和系统病例报告,收集患者的临床病理学资料,并进行回顾性分析。结果:共纳入复旦大学附属妇产科医院收治的符合标准的病例10例,中位年龄为27岁,最常见的症状为不规则阴道出血(70.0%),中位诊断距离前次妊娠时间间隔(interval since antecedent pregnancy,ISAP)为14.5个月,中位β-绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-hCG)水平为124.51 mU/mL,病灶直径为0.8~8.0 cm。复旦大学附属妇产科医院收治的10例患者经初始治疗后均获得完全缓解,平均随访时间为48.1个月,均未复发。3例患者治疗后自然受孕,其中2例足月妊娠分娩,1例因计划外妊娠行人工流产。文献复习PSTT病例显示出类似的临床病理学分布特征和疾病转归。结论:保守手术可以作为部分Ⅰ期PSTT患者的一种替代治疗方法,但需更多研究提供证据。

1例子宫剖宫产瘢痕部位侵袭性葡萄胎病例的报道分析并文献复习

子宫剖宫产瘢痕部位妊娠是剖宫产的一个潜在并发症,近年来其发生率愈见增高。而剖宫产瘢痕部位妊娠滋养细胞疾病则是与剖宫产瘢痕妊娠相关的一种特殊疾病,其诊断和治疗方面国内外现缺乏明确的指南。本文结合相关文献就烟台毓璜顶医院妇科收治的1例子宫剖宫产瘢痕部位侵袭性葡萄胎病例的诊治过程进行讨论,认为剖宫产瘢痕部位的侵袭性葡萄胎是一种特殊部位的妇科恶性肿瘤,常不易诊断,确诊后应尽早进行治疗。

子宫非典型胎盘部位结节临床病理分析

目的探讨子宫非典型胎盘部位结节的临床病理学特征、免疫表型、鉴别诊断及治疗。方法对4例子宫非典型胎盘部位结节进行镜下观察和免疫组化染色,并复习相关文献。结果4例均位于子宫腔内。组织学上表现为多个境界尚清的结节。结节内病变细胞主要为上皮样弥漫性分布,包埋于丰富的玻璃样变基质内。病变细胞体积大,胞质丰富,细胞核圆形或不规则形,有非典型性,并可见核分裂象。免疫组化上,病变细胞表达CK、CK5/6、p40和GATA3,Ki-67增殖指数为8%~20%。结论子宫非典型胎盘部位结节是一种罕见的子宫绒毛膜型中间型滋养细胞瘤样病变,容易误诊为胎盘部位滋养细胞肿瘤、上皮样滋养细胞肿瘤、鳞状细胞癌、上皮样平滑肌瘤、胎盘部位结节等,确诊需要依赖于组织学和免疫标记。

超选择动脉栓塞术在妊娠滋养细胞肿瘤治疗中的价值

目的探讨超选择动脉栓塞术在妊娠滋养细胞肿瘤治疗中的价值。方法 1999年1月至2009年12月超选择动脉栓塞治疗妊娠滋养细胞肿瘤患者86例,包括急性大出血34例和病灶内存在严重动静脉瘘52例。所有患者均接受了全身静脉化疗。结果 34例急性大出血患者接受超选择动脉栓塞后出血均得到有效控制,其中2例分别于栓塞后3、5d出血复发,经第2次栓塞后好转。52例患者存在严重子宫动静脉瘘,栓塞后造影显示动静脉瘘消失,化疗周期内未发生严重出血事件。本组86例患者中84例获随访,79例仍存活,生存率为91.9%。全组完全缓解71例(82.6%),部分缓解8例(9.3%),死亡5例(5.8%)。结论超选择动脉栓塞术可有效治疗和预防滋养细胞肿瘤原发灶或转移瘤大出血,对全身静脉化疗起到了很好的辅助作用。