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目的:探讨绒癌肺转移并发呼吸衰竭患者临床发病特点、治疗方法和预后影响因素。方法:回顾分析1983年～2010年北京协和医院收治的绒癌肺转移并发急性呼吸衰竭23例患者的临床发病特点、潜在病因、治疗方法、风险因素和结局。结果:本组23例患者中18例(78.3%)伴有肺部感染,11例(47.8%)伴有肺出血,2例胸腔积血,1例肺大泡并气胸。本组23例患者均接受了呼吸支持治疗,其中21例采用以氟尿嘧啶为主或以甲氨蝶呤为主的多药联合方案,平均化疗4.5疗程。21例患者经呼吸支持治疗和化疗后,7例(33.3%)临床完全缓解,2例(9.5%)临床部分缓解,4例(19%)放弃治疗,8例(38.1%)病情进展死亡。其中8例在呼吸衰竭急性发作期间首程采用依托泊苷+放线菌素D或放线菌素D+甲氨蝶呤联合化疗方案,6例(75%)最终临床完全缓解。结论:肺部感染、出血等肺部疾患是引起绒癌肺转移患者发生早期呼吸衰竭的常见原因。绒癌肺转移并发呼吸衰竭患者首程治疗宜采用较温和的抗肿瘤药物和治疗方案。呼吸支持同时积极化疗是治疗绒癌肺转移呼吸衰竭的重要手段。
Objective: To investigate the clinical features, treatment and prognostic factors of patients with lung metastasis of choriocarcinoma complicated with respiratory failure. Methods: The clinical features, underlying causes, treatment methods, risk factors and outcomes of 23 patients with pulmonary metastasis of choriocarcinoma complicated with acute respiratory failure admitted to Peking Union Medical College Hospital from 1983 to 2010 were retrospectively analyzed. Results: Eighteen patients (78.3%) had pulmonary infection in this group of 23 patients, including 11 cases (47.8%) with pulmonary hemorrhage, 2 cases of pleural hemorrhage, 1 case of bullae and pneumothorax. The group of 23 patients received respiratory support therapy, of which 21 patients with fluorouracil-based or methotrexate-based multi-drug combination program, the average chemotherapy 4.5 courses. Seven patients (33.3%) achieved complete remission after 21 patients were treated with respiratory support and chemotherapy. Two patients (9.5%) were partially relieved and four patients (19%) were given up their treatment. Eight patients (38.1%) died of the disease. Among them, the first course of the acute episode of respiratory failure was etoposide + actinomycin D or actinomycin D + methotrexate combined chemotherapy in 8 patients, and 6 patients (75%) eventually achieved complete clinical remission. CONCLUSIONS: Pulmonary conditions such as lung infection and bleeding are common causes of early respiratory failure in patients with lung metastasis of choriocarcinoma. Choriocarcinoma lung metastases in patients with respiratory failure should be treated first-line treatment of more moderate anti-tumor drugs and treatment options. Respiratory support while active chemotherapy is an important means of treating lung cancer lung metastasis respiratory failure.