论文部分内容阅读
目的探讨经子宫动脉化疗栓塞治疗难治性妊娠滋养细胞肿瘤及肿瘤出血的疗效。方法妊娠滋养细胞肿瘤24例,其中侵蚀性葡萄胎13例,绒毛膜癌11例,平均年龄(28.12±2.23)岁。Seldinger技术行双侧子宫动脉超选择性插管,给予肿瘤供血动脉内灌注化疗药物后,透视监视下低压流控注入聚乙烯醇颗粒(PVA)或明胶海绵颗粒(GF)栓塞,定期复查并随访。结果侵蚀性葡萄胎及绒毛膜癌数字减影血管造影(DSA)表现基本类同。动脉期肿瘤内血管明显增多、迂曲、紊乱,形态不一,成团状或丛状。7例侵蚀性葡萄胎,1例绒毛膜癌DSA造影显示明显的动静脉瘘,静脉早显。实质期肿瘤组织呈圆形或半圆形染色。24例经1～3次介入治疗后阴道出血3 d左右停止,治疗后1周血绒毛膜促性腺激素开始下降,4～16周降至正常范围。B超检查显示子宫逐渐恢复至正常大小。结论超选择性子宫动脉化疗栓塞治疗妊娠滋养细胞肿瘤疗效确切,不良反应少,尤其对原发灶或转移所致的出血和难治性病例的处理有独到之处,值得推广应用。
Objective To investigate the curative effect of transcatheter arterial chemoembolization on refractory gestational trophoblastic tumor and tumor hemorrhage. Methods 24 cases of gestational trophoblastic tumor, including 13 cases of invasive hydatidiform mole, choriocarcinoma in 11 cases, mean age (28.12 ± 2.23) years. Seldinger technique of bilateral uterine artery hyper-selective intubation, given the tumor feeding artery infusion of chemotherapy drugs, under fluoroscopy under fluoroscopy flow control injection of polyvinyl alcohol particles (PVA) or gelatin sponge particles (GF) embolization, regular review and follow-up . The results of invasive hydatidiform mole and choriocarcinoma digital subtraction angiography (DSA) performance of similar basic. Arterial tumors significantly increased blood vessels, tortuous, disorderly, in different shapes, into groups or plexuses. 7 cases of invasive mole, 1 case of choriocarcinoma DSA angiography showed significant arteriovenous fistula, veins early. Substantial tumor tissue was round or semi-circular staining. 24 cases of vaginal bleeding after 1 to 3 interventions stopped about 3 d, 1 week after treatment, serum chorionic gonadotropin began to decline, 4 to 16 weeks to the normal range. B-ultrasound showed that the uterus gradually returned to normal size. Conclusion Superselective uterine arterial chemoembolization for treatment of gestational trophoblastic tumor has definite curative effect and few adverse reactions. It is worthy of popularization and application, especially for the treatment of hemorrhage and refractory cases caused by primary tumor or metastasis.