Zhao Jun, Xiang Yang, Guo Lina, Wan Xirun, Feng Fengzhi, Ren Tong
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
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Zhonghua Fu Chan Ke Za Zhi. 2014 Apr;49(4):265-9.
To approach the efficiency and feasibility of preserving the fertility for patients with placental site trophoblastic tumor (PSTT).
Totally 2 086 cases of gestational trophoblastic neoplasm (GTN) patients registered in Peking Union Medical College Hospital between 1998 and 2013. Fifty-seven of them were PSTT patients, 40 cases of which suffered hysterectomy, the rest 17 PSTT patients who preserved their fertility were analyzed retrospectively. The computerized database of clinical and pathological reports was reviewed in this cohort.
The clinical manifestation of PSTT was not specific compared to other types of GTN. The average age of the 17 patients was 29.5 years old (range 22-39 years). The most common antecedent pregnancy was term birth (8 cases), the others were spontaneous abortion in 4 case, artificial abortion in 3 cases and molar pregnancy in 2 cases. The baseline serum β-hCG was slightly elevated and 12 patients (12/15) were less than 1 000 U/L. In this cohort, nine of the patients were in stage I, while the other eight cases were in stage III . The patients suffered conservative surgery, including dilation and curettage of uterus in 7 cases, open abdomen uterine lesion excision in 4 cases, laparoscopic uterine lesion excision in 3 cases, hysteroscopic uterine lesion excision in 1 case, and pulmonary lobectomy in 2 cases. Two of the patients didn't received chemotherapy, while the other 15 cases suffered combination chemotherapy. Compared with 40 patients who suffered hysterectomy during the same interval, fertility preservation group did not result in poor outcomes or high risk of relapse rate. Six subsequent pregnancies happened after the therapy, two of them were during their second-trimester, while four patients had healthy babies by vaginal delivery in two and cesarean section in two. The scar of the uterus was fairly well during the cesarean sections.
Reservation of fertility therapy could be considered in highly-selected patients for young women who strongly desired to preserve their fertility and with localized lesion. Exactitude follow-up after therapy should be recommended. Contraception should also be recommended for at least one year after the chemotherapy. Vaginal delivery could be an option for the future pregnancies.
探讨保留胎盘部位滋养细胞肿瘤（PSTT）患者生育功能的有效性和可行性。
回顾性分析1998年至2013年在北京协和医院登记的2086例妊娠滋养细胞肿瘤（GTN）患者。其中57例为PSTT患者，40例行子宫切除术，其余17例保留生育功能的PSTT患者进行回顾性分析。查阅该队列临床及病理报告的计算机数据库。
与其他类型的GTN相比，PSTT的临床表现不具有特异性。17例患者的平均年龄为29.5岁（范围22 - 39岁）。最常见的前次妊娠为足月产（8例），其他依次为自然流产4例、人工流产3例、葡萄胎妊娠2例。基线血清β - hCG轻度升高且12例患者（12/15）低于1000 U/L。该队列中，9例患者为Ⅰ期，8例为Ⅲ期。患者接受了保守性手术，包括7例行子宫扩张刮宫术、4例行开腹子宫病灶切除术、3例行腹腔镜子宫病灶切除术、1例行宫腔镜子宫病灶切除术、2例行肺叶切除术。2例患者未接受化疗，其他15例接受联合化疗。与同期40例行子宫切除术的患者相比，保留生育功能组未导致不良结局或高复发风险。治疗后发生6次后续妊娠，其中2次为孕中期妊娠，4例患者经阴道分娩2例、剖宫产2例产下健康婴儿。剖宫产时子宫瘢痕情况良好。
对于强烈希望保留生育功能且病变局限的年轻女性患者，可在严格筛选后考虑保留生育功能治疗。建议治疗后进行精确随访。化疗后至少一年内也应建议避孕。未来妊娠可选择经阴道分娩。
