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目的评估妊娠滋养细胞肿瘤(GTN)泌尿系转移患者的治疗及预后。方法对1987年1月至2005年12月在北京协和医院就治的19例GTN泌尿系转移患者进行回顾性分析,其中膀胱转移10例,肾转移9例,同时发生膀胱及肾转移的有2例。所有患者均接受以5-氟尿嘧啶(5-FU)为主的联合化疗或EMA-CO化疗,5例患者同时行5-FU膀胱灌注。7例患者行选择性动脉插管栓塞或化疗。5例合并脑转移的患者接受联合化疗同时行甲氨蝶呤(MTX)鞘内注射。结果经过2～22个疗程的化疗后19例患者中11例完全缓解,2例血生化指标缓解带瘤存活,2例住院化疗期间病情恶化放弃治疗,4例合并脑转移死亡。结论GTN膀胱转移患者经过正规的全身加局部化疗预后较好,而肾转移的患者预后相对较差。选择性动脉插管栓塞可以作为急诊处理膀胱转移合并阴道转移大出血患者的首选方法。
Objective To evaluate the treatment and prognosis of patients with gestational trophoblastic tumor (GTN) urinary tract metastasis. Methods 19 patients with GTN urinary tract metastasis treated at Peking Union Medical College Hospital from January 1987 to December 2005 were retrospectively analyzed. Among them, 10 cases were bladder metastasis, 9 cases were renal metastasis, and 2 cases were bladder and renal metastasis example. All patients received 5-fluorouracil (5-FU) -based combination chemotherapy or EMA-CO chemotherapy, and 5 patients underwent 5-FU intravesical instillation. Seven patients underwent selective arterial embolization or chemotherapy. Five patients with brain metastases received combined intrathecal methotrexate (MTX) intrathecal injection. Results After 2 to 22 courses of chemotherapy, 11 of 19 patients were completely relieved, 2 of them were relieved of tumorigenicity with blood biochemical indexes, 2 were treated with chemotherapy after hospitalization, and 4 died of brain metastasis. Conclusions The prognosis of patients with GTN bladder metastasis after formal systemic plus local chemotherapy is better, while the prognosis of patients with renal metastases is relatively poor. Selective arterial embolization may be the first choice for emergency treatment of patients with bladder metastasis and vaginal bleeding.