[Evaluation of emergency surgery in gestational trophoblastic tumours]

We retrospectively analyzed 27 cases of gestational trophoblastic neoplasia treated by emergency surgery from 1985-1996 at PUMC hospital. Seventeen cases were diagnosed of choriocarcinoma and 10 were invasive mole. Sixteen out of 27 patients were subjected to hysterectomy because of uterine perforation or severe uterine bleeding; 4 cases received unilateral oophorectomy because of torsion of theca lutein cyst. Emergency open surgery and excision of the metastatic brain tumour were undertaken in 3 patients with elevated intracranial pressure caused by brain edema and haemorrhage; 2 patients showed lifethreatening haemorrhage from vaginal metastatic tumour and were managed by operative intervention. Partial jejunectomy was performed in 2 patients due to rupture of jejunal metastatic mass. Of these 27 cases, 17 hadn't been treated with chemical reagents and 6 cases had received one course of chemotherapy before surgical procedures. After multiple courses of combined chemotherapy postoperatively, 23 patients had achieved complete remission. It is concluded that surgical intervention plays an important role in patients with trophoblastic disease when emergency situations (e.g. life-threatening haemorrhages) occur; early diagnosis and prompt initiation of chemotherapy might have rendered surgery unnecessary.