edited GTT_2010(易晓芳)幻灯片.ppt

妊娠滋养细胞疾病GESTATIONAL TROPHOBLASTIC DISEASE 易 晓 芳 复旦大学附属妇产科医院 2010-11 References Soper JT et.al. ACOG Practice Bulletin No. 53. Gynecologic Oncology. 2004, 93: 575-585. From Eifel PJ, Gershenson DM, Kavanagh JJ, Silva EG: Gynecologic Cancer (M.D. Anderson Cancer Center Series, Buzdar AU, Freedman RS, eds). New York, Springer, 2006, p 235.) Crum CP and Lee KR. Diagnostic Gynecologic and Obstetric Pathology, 2007. Berkowitz RS and Goldstein DP. Novak’s Gynecology, 14th eds. 2007. Kavanagh JJ and Gershenson DM. Chapter 35?–Comprehensive Gynecology, 5th ed. 2007. 谢幸. 妊娠滋养细胞疾病. 妇产科学第7版, 乐杰主编. 2008. 教 学 目 的 滋养细胞的功能The Role of Trophoblasts 胎盘的重要细胞组分 介导胚胎种植 保护胎儿免受母体免疫攻击 传递营养，去除废物 合成激素 “假恶性”表现: 浸润 快速增殖 血源播散 受免疫监视 Epidemiology of HM Incidence: 1: 400 ~ 1: 2000 pregnancies Risk factors: Maternal age：20 or 35 (HR=2)， 40 (HR=7.5) Hist. of hydatidiform mole：increase by 20-40 times Previous RSA (recurrent spontaneous abortion) Poor nutrition Oral contraceptive use Pathogenesis of HM All placental villi are swollen Fetal tissues are absent 镜下： 弥漫性绒毛水肿 (hydatidiform change) 弥漫性滋养细胞增生 (trophoblastic hyperplasia) 绒毛内缺乏血管 (loss of fetal blood vessels) Some chorionic villi are swollen Fetal tissues are present Symptoms Signs Abnormal bleeding (80%) Uterus large for dates (~30%) Enlargement of ovaries (~20%) Nausea, vomiting, hyperemesis gravidarum (8%) Preeclampsia (1:74) Abdominal pain Hyperthyroidism Theca Lutein Ovarian Cyst Diagnosis of HM History Clinical examination Ultrasound Scan: the most valuable tool Serum hCG levels Other work-up: FCM, Chest X-ray, Blood testing… Histologic examination Differential Diagnosis: Abortion Multiple pregnancy Hydramnios Ectopic pregnancy Management of HM Once diagnosed, the uterus should be evacuated. Medical complications should be assessed and corrected when necessary. Suction Curettage (gently,slowly completely) 输液、备血、手术室、有经验医师进行 充分扩张宫颈管、9-12号吸管+刮匙，术中可用缩宫素 刮出物：选靠宫壁的新鲜组织送病理 Theca-Lutein Cysts： Generally regress in 2-4 mo