妊娠滋养细胞肿瘤彩色多普勒超声的诊断价值_临床医学论文.docVIP

妊娠滋养细胞肿瘤彩色多普勒超声的诊断价值_临床医学论文 妊娠滋养细胞肿瘤彩色多普勒超声的诊断价值_临床医学论文 作者：谢晴 周琦 雷小莹 安芳 吴静 刘惠喜 【摘要】 　　目的：总结彩色多普勒超声诊断妊娠滋养细胞肿瘤的应用价值，并进行疗效观察。方法：应用彩色多普勒超声诊断218例妊娠滋养细胞肿瘤，并进行随访观察。随访指标为血窦大小、血窦阻力指数、子宫肌壁血流，并结合血清绒毛膜促性腺激素（β-hCG）。 结果：218例妊娠滋养细胞肿瘤中（侵蚀性葡萄胎186例，绒毛膜癌32例）随访195例，占病例总数89%，其中2例侵蚀性葡萄胎转京治疗，2例绒癌死亡，其余191例妊娠滋养细胞肿瘤（绒毛膜癌30例、侵蚀性葡萄胎161例）经化疗后血窦消失，肌壁血流显示正常，同时β-hCG恢复正常。结论：彩色多普勒超声结合临床可协助准确诊断妊娠滋养细胞肿瘤并进行疗效观察。 【关键词】 彩色多普勒超声；妊娠滋养细胞肿瘤 AbstractObjective：To review clinical data of gestation trophoblastic tumor cases diagnosed by color Doppler ultrasonography and to follow up the curative effect. Methods: Total 218 patients with gestation trophoblastic tumor were studied by color Doppler and fllowed up. Such fllow-up indexes as the size of blood sinuses，the blood flow resistance index (RI) , uterine muscular layer blood flow and β-hCG were studied. Results: Of 218 cases of gestation trophoblastic tumour(186 cases of invasive hydatidiform mole and 32 cases of choriocarcinoma), 195 cases (89％) were followed-up. Excepting that 2 invasive hydatidiform mole had been transferred to Beijing and 2 choriocarcinoma had died after chemotherapy, the blood sinuses of 191 cases (30 choriocarcinoma, 161 invasive hydatidiform mole) disappeared after chemotherapy, the flow resistance index (RI) , uterine blood muscular layer flow and β-hCG became nomal. Conclusion: Associated with clinic, color Doppler can be used to accurately diagnose gestation trophoblastic tumour and to observe the curative effect. Key words Color Doppler Ultrasound; Gestation trophoblastic tumor 侵蚀性葡萄胎、绒毛膜癌是来源于胚胎的滋养细胞疾病，早期诊断、定期复查及疗效评估方面已成为人们关注重点[1]。本文总结应用彩色多普勒超声诊断妊娠滋养细胞肿瘤的价值，并结合临床对其疗效进行观察。 　　1资料与方法 　　1.1 临床资料 　　1991-2004年在西安交通大学第二医院及第一医院就诊妊娠滋养细胞肿瘤218例，年龄26.9±8.7岁；其中：侵蚀性葡萄胎186例，绒毛膜癌32例（17例发生于葡萄胎后，10例发生于流产后，4例发生于足月产后，1例发生于宫外孕后）。临床分期（FIGO,2000）：侵蚀性葡萄胎Ⅰ135例、Ⅱ20例、Ⅲ30例、Ⅳ1例；绒毛膜癌Ⅰ19例、Ⅱ6例、Ⅲ5例、Ⅳ2例。临床症状：均出现阴道不规则出血、月经不调、腹痛及排液。其中7例侵蚀性葡萄胎、4例绒毛膜癌出现咳嗽或咯血，2例侵蚀性葡萄胎、1例绒毛膜癌出现头痛昏厥。临床体征：均表现子宫增大变软。其中68例侵蚀性葡萄胎和4例绒毛膜癌一侧附件区扪及囊性包块，118例侵蚀性葡萄胎和28例绒毛膜癌双侧附件区扪及囊性包块； 20例侵蚀性葡萄胎和1