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中间型滋养细胞肿瘤保留生育功能的治疗
Fertility Sparing Therapy in Patients with Intermediate Trophoblastic Tumors
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摘要:目的 探讨中间型滋养细胞肿瘤(intermediate trophoblastic tumors, ITTs)保留生育功能治疗的方法并分析其结局。方法 对1999年1月至2010年3月在本院行保留生育功能治疗的6例ITTs进行回顾性分析。结果 诊刮有效2例、化疗敏感2例、开腹子宫病灶切除术有效3例。3例病理大体类型为结节息肉型ITTs, 行诊刮+联合化疗有效; 3例肿块型ITTs, 行开腹子宫病灶切除术+联合化疗±诊刮有效。平均随诊35个月, 均获得完全缓解(completeremis-sion, CR), 月经均恢复正常, 随访至今无复发。3例有足月生产史者未再妊娠, 3例未生产者至今尚未妊娠。结论 ITTs患者年龄 < 35岁(强烈要求保留生育功能), 病变局限于子宫, 且除外子宫多发病灶(病理弥漫浸润型)行保留生育功能的治疗是安全可行的。Abstract:Objective To investigate the methodologies of fertility sparing therapy in treating intermediate trophoblastic tumors (ITTs) and analyze their outcomes.Methods The clinical data of 6 patients with ITTs who underwent fertility sparing therapy in our department from January 1999 to March 2010 were retrospectively analyzed.Results Serum β-hCG of two patients returned normal after treated by dilation and curettage. Serum β-hCG of two patients returned normal after two courses of combined chemotherapy. Three patients were cured after open uterine tumor resection and combined chemotherapy. The gross pathology of three ITTS were polypoid, which were controlled by combined chemotherapy following dilation and curettage. Two of three patients with nodular masses type were cured by a multi-modality treatments that combined dilation and curettage with chemotherapy, followed by open uterine tumor resection (the other one did not undergo dilation and curettage). The average follow-up time was 35 months. All patients experienced complete remission (CR). Menstruation returned normal in all patients. No recurrence was noted during follow-up. No one had been pregnant.Conclusions Fertility sparing therapy is safe and feasible for ITTs patients under the following conditions:younger than 35 years and having a strong wish to get pregnant in future; the tumor is localized in uterus; and multifocal disease (the diffuse infiltrative type) has been excluded.
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