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目的探讨低危型妊娠滋养细胞肿瘤耐药的相关高危因素。方法收集2000年1月至2010年1月浙江大学附属妇产科医院收治的452例低危型妊娠滋养细胞肿瘤患者的资料,根据耐药与否分为耐药组(86例)和非耐药组(366例)进行回顾性分析。结果耐药发生率为19.03%。初始化疗前高HCG值(尤其是血HCG值>10000U/L)者、肺部有多处转移灶、有远处转移、子宫大病灶者易发生耐药。绒癌较侵蚀性葡萄胎易发生耐药。另外化疗副反应大、对化疗药物敏感导致疗程和剂量不足、疗程间隔过长的也易产生耐药。而年龄、临床分期、先期妊娠性质、化疗药物及给药途径、初次化疗至末次妊娠终止的间隔时间方面两组比较差异无统计学意义(P>0.05)。结论化疗方案应个体化,对耐药的高危人群应及早合理联合用药,重视结合手术等综合治疗,可降低耐药率,提高治愈率。
Objective To investigate the risk factors of low-risk gestational trophoblastic tumor drug resistance. Methods The data of 452 cases of low-risk gestational trophoblastic tumor admitted to Affiliated Obstetrics and Gynecology Hospital of Zhejiang University from January 2000 to January 2010 were collected and divided into drug-resistant group (86 cases) and non-resistant group Drug group (366 cases) were retrospectively analyzed. Results The incidence of drug resistance was 19.03%. High initial HCG HCG value (especially blood HCG value> 10000U / L), the lungs have multiple metastases, distant metastasis, large uterine lesions prone to drug resistance. Choriocarcinoma more likely to develop resistance to invasive mole. In addition, side effects of chemotherapy, chemotherapeutic drugs lead to inadequate treatment and dose, treatment interval is too long also prone to drug resistance. There was no significant difference between the two groups in terms of age, clinical stage, pre-pregnancy, chemotherapeutic drugs and route of administration, and interval from the initial chemotherapy to the end of the last trimester of pregnancy (P> 0.05). Conclusion The chemotherapy regimen should be individualized. The high-risk drug-resistant population should be combined with reasonable early and combined with comprehensive treatment such as surgery can reduce the drug resistance rate and improve the cure rate.