Role of surgical therapy in the management of gestational trophoblastic neoplasia.
Role of surgical therapy in the management of gestational trophoblastic neoplasia.
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DOI：
10.5468/ogs.2015.58.4.277
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发表时间：
2015-07-01
影响因子：
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通讯作者：
Kim, Young Tae
中科院分区：
文献类型：
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作者：
Eoh, Kyung Jin;Chung, Young Shin;Kim, Young Tae
目的：评估辅助手术在妊娠滋养细胞肿瘤（GTN）治疗中的作用：在回顾性分析Severance医院的病历中，我们确定了1986年至2006年期间诊断为GTN的174例患者。在174例患者中，129例（74%）被分配至非转移组，45例（26%）被分配至转移组;在转移组患者中，6例为低风险组，39例为高风险组。作为GTN治疗的一部分，32名患者接受了35次外科手术。手术方法包括子宫切除术、肺切除术、开颅术、子宫楔形切除术、出血性子宫切除术、输卵管卵巢切除术、治疗前刮宫术、肾上腺切除术、肾切除术和子宫动脉栓塞术。11例患者在接受一种或多种化疗方案后因化疗耐药疾病接受了手术。12例患者接受了控制肿瘤出血的手术。11例化疗耐药患者中有9例（81%）存活，8例因化疗耐药疾病接受挽救手术的患者接受了进一步化疗。在21例接受子宫切除术的患者中，19例（90%）获得缓解。所有的三个病人谁有耐药的绒毛膜癌病灶在肺实现缓解通过肺切除术。结论：辅助外科手术，特别是子宫切除术和肺切除术的化疗耐药的疾病，以及控制出血的程序，是关键的GTN的管理。
OBJECTIVE: To evaluate the role of adjuvant surgical procedures in the management of gestational trophoblastic neoplasia (GTN).METHODS: In a retrospective review of medical records at the Severance Hospital, we identified 174 patients diagnosed with GTN between 1986 and 2006. Of the 174 patients, 129 (74%) were assigned to the nonmetastatic group, and 45 (26%) to the metastatic group; of the metastatic group patients, 6 were in the low-risk group and 39 were in the high-risk group. Thirty-two patients underwent 35 surgical procedures as part of the GTN treatment. The procedures included hysterectomy, lung resection, craniotomy, uterine wedge resection, uterine suturing for bleeding, salpingo-oophorectomy, pretherapy dilatation and curettage, adrenalectomy, nephrectomy, and uterine artery embolization.RESULTS: Of the 32 patients who underwent surgical procedures, 28 (87%) survived. Eleven patients underwent surgery for chemoresistant disease after receiving one or more chemotherapy regimens. Twelve patients underwent procedures to control tumor hemorrhage. Nine (81%) of 11 patients with chemoresistant disease survived, and 8 patients who underwent salvage surgery for chemoresistant disease received further chemotherapy. Of 21 patients who underwent hysterectomy, 19 (90%) achieved remission. All of three patients who had resistant foci of choriocarcinoma in the lung achieved remission through pulmonary resection.CONCLUSION: Adjuvant surgical procedures, especially hysterectomy and pulmonary resection for chemoresistant disease, as well as procedures to control hemorrhage, are pivotal in the management of GTN.