| Hydatidiform mole is one kind of carcinoid that belong to gestational trophoblastic disease, but hydatidiform mole have potential competence transfor- m malignancy. Hydatidiform mole villus radicel amass liquid, form big and small hydatid like grape so we named hydatidiform mole. Because of idiographic histological origin and character of biology, it is one of tumour that can be cured at the earlist time. In recent years, with the progress of the study, diagnosis has improved continuously, resistance to further solve the problem, treatment methods to improve the cure rate makes Hydatidiform mole improvd so that patients suffering from the disease not only receive effective treatment and be able to retain fertility.Generally occur in patients with hydatidiform mole after the sudden menopausal vaginal bleeding ; abdominal discomfort associated with irregular vaginal bleeding; appear heavier clinical response early pregnancy symptoms. Such as patients not treated in time will appear in shock, the deterioration of hydatidiform mole or distant metastasis, a serious hazard to the physical and mental health of women.With the rapid development of interventional technology in recent years, the field of interventional therapy gradually expanded, from the success of the treatment of the early gynecologic malignancies, postpartum hemorrhage, to the uterine fibroids and Adenomyosis, after the clearance uterus chemotherapy resistance unsatisfactory mole interventional treatment has also been made an ideal treatment. We apply seldinger's technology to puncture the right femoral artery, in conjunction with the guide wire, we use the ordinary Milk 5.0F catheter from Cook to carry out the left side of the internal iliac artery angiography in order to clear mole of unilateral blood supply situation, angiography confirmed complete tumor staining patterns no defect area to 0.25g of 5-Fu treatment of intra-arterial line, using high-pressure syringe to maintain 15 minutes of reperfusion time in order to enable the tumor to be a long time to high concentrations of anti-drug role. Then with 10ml of 48% lipiodol emulsion 0.5g of 5-Fu arterial embolization, because of the existence of many tumor mole arteriovenous fistula, thus resulting in the embolization must be observed in the process of draining veins of the situation, once the draining veins iodized oil particles appear, immediate cessation of embolization. At the same time, inquiries should always in patients with respiratory conditions, in patients with chest tightness, dyspnea, throat itching, cough, there is spicy exhaled gases, such as stimulating the taste of any one of the symptoms of pulmonary embolism should be an immediate cessation of embolization, should not have the pursuit of a complete tumor filling and practical work generally unilateral embolization of lipiodol 5ml dosage at about lipiodol in the tumor was scattered deposition. At this point with 2X40mm gelfoam twine the Article 2～3 completely blocked the uterine artery to cut off the tumor's blood supply. Milk catheter will be the same after the molding method of mole tumor blood vessels supplying the right to interventional therapy.Application of the method of treatment of patients will appear:①. Ischemic pain: 28 patients (77.8%) appeared after treatment at different levels of the lower abdomen and lumbosacral swell pain, pain is paroxysmal, commonly arise in the immediate completion of embolization, there is also at embolization in the treatment of patients with 4～6 hours after the pain symptoms, continued to 2～3 days to ease gradually to disappear, without special treatment, given strong pain symptoms or fentanyl paste can set to achieve analgesic effect; the other 8 patients (22.2%) had no significant discomfort.②. Fever, vomiting: There are 8 patients (22.2%) after one week a rise in body temperature, generally around body temperature at 38℃, showing a clear bimodal hot afternoon and evening, the body temperature are normal in patients with the early morning. Routine blood test results normal, no need for special treatment, symptoms disappeared after 1 week; has 24 patients (66.7%) vomiting situation, usually after the completion of embolization in the treatment of 1～3 hours, 1～2 days after sustained remission gradually to disappear, No special disposal.③puncture site hematoma: embolization completed, the puncture point compression bandaging 24h, no one happened Example puncture site hematoma.④lower extremities ache powerlessness: there is two cases (5.6%) appeared after 24 hours of lower extremity ache powerlessness, search of lower extremity skin temperature and color to normal fluctuations in good dorsalis pedis artery was not given any disposal, one week after the symptoms disappear naturally .⑤irregular vaginal bleeding: 36 patients have nine cases of patients with no vaginal bleeding situation, after interventional therapy were all very small amount of vaginal bleeding. Pink blood-like, and there is dark of slag, floccus objects generally continued for 3～5 days after treatment may not be sufficient to maintain the blood supply of uterine endometrial growth led to a small number of endometrial shedding relevant. 36 cases of patients with bilateral uterine artery embolization at follow-up after 2 years, no one cases of uterine necrosis happen, and has 16 cases of patients with normal pregnancy and a smooth production.HCG values before treatment in patients with an average of: 216,000 IU / L; interventional treatment for 3 days on average: 16,000 IU / L; interventional treatment for 7 days on average:7,000 IU / L; interventional therapy an average of 14 days: 670IU / L; interventional treatment for 30 days on average: 37IU / L; interventional treatment of patients after 90 days of all HCG values were in stable condition at the normal range. HCG value of the control group of patients with an average of: 209,000 IU / L; have six cases (14.3%) patients with chemotherapy invalid, HCG value of continuing the high level did not fall, and the deterioration of the patients to take surgery to remove the uterus. Patients were followed up for 2 years, a significant treatment effect were 25 cases, accounting for 69.4%; effective in 11 cases, accounting for 30.6%; in this group have not been cases of interventional therapy in patients with null and void.We observed that uterine artery embolization in the treatment of the most significant clinical effect is significantly reduced in patients with hydatidiform mole amount of vaginal bleeding. If a large number of patients with vaginal bleeding when they seek medical treatment, in order to avoid continued loss of blood should be immediately uterine artery embolization for the treatment, the group has four cases of patients with this type of situation is, according to B-and HCG in patients with a history of value and to determine the diagnosis immediately after the interventional therapy , treatment significantly reduced the day of vaginal bleeding, bilateral artery embolization after 3 days, vaginal bleeding stopped 2 months after the menstrual, menstrual volume and the menstrual cycle has returned to normal. In addition, we observed that the volume of preoperative mole older, more abundant blood supply, treatment reduced the proportion of tumor sooner.What is clear now also affects the menstrual cycle. The vast majority of women had embolization Although there is reduction of blood supply but the menstrual cycle is normal. Only a small number of women in the surgery done after the cessation of menstrual periods, while the majority of them are pre-menopausal age women after menopause, whether it is because of reduced postoperative ovarian function caused by still not sure. The intervention group received treatment of 36 cases of patients with hydatidiform mole have been 16 cases in 2 years after treatment of normal pregnancy and a smooth production. And have data to support the bulk of patients with hydatidiform mole after treatment is received chemotherapy, the normal reproductive capacity and no significant difference.In summary, we believe that the therapeutic effects of interventional therapy hydatidiform sure, but also the suffering of small, easily patients, gynecological treatment of hydatidiform mole are new ways for the young, need to retain reproductive function of patients is particularly important. |
PDF Full Text Request