| Objective To investigate the outcome of the gestational trophoblastic neoplasia patients who has undergone the feritility-sparing surgery of localized resection of uterus.Methods Date on a total 479 GTN patients in Women Hospital affiliated Zhejiang University from 1991.3 to 2005.3 were reviewed,31 patients were selected studied and followed up.Results Three cases underwent emergency surgery because of bleeding and shock. Four cases was misdiagnosed as ectopic pregnancy. Except one patient who had normal serum HCG and the lesion is localized on admission,23 cases (2 cases of high risk, low risk n=21) preoperatively to ACM/EMACO 1-10 cycles of chemotherapy with an average of 4.6 before surgery, and surgery was practiced in the chemotherapy or in the interval of chemotherapy when the necrosis localized on uterus. The serum HCG decreased 9.3%-100%after surgery. We completely removed 30 foucus lesions with maximum diameter 1.5-8cm; Of 23 cases preoperative chemotherapy, lesions 1-2cm and 2.1-3cm by the ratio of≤50ml blood loss were 4/9,2/7, The difference was not statistically significant (χ2 test p= 0.900), the same resoult while in lesions were≤3cm, with >3cm(x2 test p= 0.975). and 30 cases combined with chemotherapy after surgery until serum HCG down to normal for 0-5 cycles except one who has a normal HCG. Only one case Suspended of the following chemotherapy, the other 30 cases achieved remission. Up to 27 cases, the pregnancy rate was 88.9%, the procreation rate was 81.5%.Conclusion Localized resection of uterus has the function of removal of primary tumor, preserve fertility function in the treatment of gestational trophoblastic neoplasia in young patients with lesions confined to the uterus, and a reproductive demands,and with the vast majority of good pregnancy outcomes, it has some value. |
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