Teoh E S
Teoh Clinic for Women, Shaw Centre, Singapore.
Obstet Gynecol Clin North Am. 1988 Sep;15(3):545-64.
The cure of trophoblastic disease depends on early recognition and appropriate chemotherapy. In many areas in Asia, doctors face the problems of insufficient funds and poor patient compliance with follow-up. In such situations, the maximum returns for the minimum input would consist of: 1. Routine ultrasound diagnosis for irregular vaginal bleeding associated with amenorrhea; 2. In hydatidiform mole, hysterectomy for women above 40 and those who have completed their families; prostaglandin and suction curettage for evacuation; 3. Prophylactic methotrexate-folinic acid, or dactinomycin or 5-FU for high-risk cases; 4. Follow-up by the simplified regimen using hCG test kits; 5. Chemotherapy with hysterectomy for choriocarcinoma, whether localized in the uterus or metastatic: if the uterus is to be conserved, there must be a good reason; 6. Multiagent chemotherapy as first line in all high-risk cases; and 7. In view of the excellent results with 5-FU in China, investigation of this drug elsewhere, initially in metastatic mole.
滋养细胞疾病的治疗取决于早期诊断和适当的化疗。在亚洲的许多地区，医生面临着资金不足和患者随访依从性差的问题。在这种情况下，以最小投入获得最大回报的方法包括：1. 对与闭经相关的不规则阴道出血进行常规超声诊断；2. 对于葡萄胎，40岁以上及已完成生育的女性行子宫切除术；使用前列腺素和刮宫术进行排空；3. 对高危病例预防性使用甲氨蝶呤-亚叶酸、放线菌素D或5-氟尿嘧啶；4. 使用hCG检测试剂盒采用简化方案进行随访；5. 对于绒毛膜癌，无论其局限于子宫还是发生转移，均行化疗加子宫切除术：若要保留子宫，必须有充分理由；6. 所有高危病例均将多药联合化疗作为一线治疗；7. 鉴于5-氟尿嘧啶在中国取得了良好疗效，其他地区应首先在转移性葡萄胎中对该药物进行研究。
