低危妊娠滋养细胞肿瘤首次化疗失败后的补救方案

发布时间：2018-06-17 17:04

本文选题：低危妊娠滋养细胞肿瘤 + 化疗MTX　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：研究低危妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia, GTN)在首次甲氨蝶呤(methotrexate, MTX)方案化疗失败后予以放线菌素D (actinomycin D, ACTD)补救方案的治疗效果及影响其疗效的因素。方法：回顾分析2000年6月至2009年6月在浙江大学附属妇产科医院住院的低危妊娠滋养细胞肿瘤患者(53例)在首次MTX方案化疗失败后予以ACTD治疗方案,部分患者结合手术治疗方案后的临床反应,并通过t检验及卡方分析影响其治疗效果的因素。结果：在53例患者中,40例为MTX耐药患者,13例为MTX毒副反应不能耐受而换药患者。41例(77.4%)患者在接受以ACTD方案化疗为主的综合治疗后得到完全缓解,11例(20.8%)患者在两次单药化疗方案失败后接受以EMA/CO方案化疗为主的综合治疗方案后得到缓解,1例(1.9%)患者在EMA/CO方案失败后接受以EP/EMA化疗方案为主的治疗后得到缓解。所有患者中并未发生致命性的毒副反应,主要的毒副反应为骨髓功能抑制,胃肠道反应,肝肾功能受损及皮肤黏膜溃疡形成。影响初次MTX方案失败后ACTD方案的治疗效果因素主要是更换治疗方案前患者的HCG水平以及更换化疗方案的原因。结论：低危妊娠滋养细胞肿瘤在首次MTX方案治疗失败后可考虑以ACTD方案作为补救方案,可得到较好的缓解率。MTX方案和ACTD方案两次单药化疗方案失败的原因与决定更换方案前的血HCG水平以及更换方案的原因相关。
[Abstract]:Aim: to study the efficacy of actinomycin D actinomycin (ACTD) regimen in the treatment of gestational trophoblastic neoplasia (GTNA) in low-risk gestational trophoblastic neoplasms after the first methotrexate (MTX) regimen failed. Methods: from June 2000 to June 2009, 53 patients with low-risk gestational trophoblastic neoplasms hospitalized in the affiliated Obstetrics and Gynecology Hospital of Zhejiang University were treated with ACTD after the first MTX regimen failed. Part of the patients combined with the clinical response of the surgical treatment, and through t test and chi-square analysis of the factors affecting its therapeutic effect. Results: of the 53 patients, 40 were MTX resistant patients and 13 were MTX side effects intolerant patients. 41 patients were treated with ACTD regimen chemotherapy and 11 patients had complete remission after receiving ACTD regimen chemotherapy. After the failure of the single drug chemotherapy regimen, one patient received remission after receiving a comprehensive chemotherapy regimen consisting mainly of EMA-r-CO regimen.) after the failure of the EMA / EMA regimen, the patients were relieved after receiving the EMA / EMA regimen. There were no fatal side effects in all patients. The main side effects were bone marrow function inhibition, gastrointestinal reaction, liver and kidney function impairment and skin and mucosal ulcer formation. The main factors affecting the efficacy of ACTD regimen after the first MTX regimen failure were the HCG level of patients before the replacement of the treatment regimen and the reasons for the replacement of chemotherapy regimen. Conclusion: ACTD regimen may be considered as a remedy for trophoblastic neoplasms in low risk pregnancy after the first MTX regimen failed. The reasons for the failure of MTX regimen and ACTD regimen were related to the blood HCG level before the change of the regimen and the reason of the replacement regimen.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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