子宫切除对治疗滋养细胞肿瘤价值的探讨

目的 评价子宫切除手术在滋养细胞肿瘤治疗中的作用。方法 对６８例行子宫切除术的滋养细胞肿瘤病例进行回顾性分析，其中侵蚀性葡萄胎３０例，绒癌３８例，结果２３例因年龄偏大，且无生育要求，术前经短暂化疗后，择期行全子宫切除术，２２例获完全缓解，总平均化疗程数为４．２。２７例因产生化疗耐药，且考虑病灶主要局限于子宫，在化疗的同时进行了全子宫切除术，２０例（７４．１％）获完全缓解，总平均化疗程数为９．４。

The role of hysterectomy in the therapy of gestational trophoblastic tumor

OBJECTIVE: To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. METHODS: A total of 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985-1997 at PUMC hospital was retrospectively analyzed. Thirty-eight cases were diagnosed as choriocarcinoma and 30 as invasive mole. RESULTS: Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after short courses of chemotherapy. Twenty-two of them had complete remission (95.6%). The average total course of chemotherapy was 4.2. Of twenty-seven chemo-refractory cases who were suspected of an isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed. Twenty of them achieved complete remission (74.1%), with an average 9.4 courses of chemotherapy. Emergency hysterectomy was indicated in 18 patients with uterine perforation or life-threatening hemorrhage. Seventeen of the emergent cases had complete remission (94.4%), who had received an average 7.6 courses of chemotherapy. CONCLUSION: Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjunct treatment in a selected subset of patients. Modified radical hysterectomy is recommended for the indicated patients.