宫腔镜在妊娠滋养细胞疾病诊治中的应用.docVIP

宫腔镜在妊娠滋养细胞疾病诊治中的应用 　　[摘要] 目的 探讨宫腔镜对妊娠滋养细胞疾病诊断和治疗的临床价值。 方法 回顾性分析2013年1月～2017年1月北京妇产医院妇瘤科收治的均接受过宫腔镜检查的69例妊娠滋养细胞疾病患者的临床资料，分析诊治结局。 结果 69例患者中，42例诊断为葡萄胎，其中5例首次宫腔镜监测下葡萄胎清宫术，37例为宫腔镜下再次清宫术，42例均无术后残留发生。27例诊断为妊娠滋养细胞肿瘤，其中24例诊断为侵蚀性葡萄胎、2例绒毛膜癌，通过单药或联合化疗后，获完全缓解。PSTT 1例，经过开腹子宫肌壁病灶切除的保守性手术而治愈。27例滋养细胞肿瘤患者严密随访，均无复发。69例患者手术顺利，无并发症发生。 结论 宫腔镜下葡萄胎再次清宫术，安全有效。宫腔镜有助于妊娠滋养细胞肿瘤的明确诊断，对预后无影响。 　　[关键词] 妊娠滋养细胞疾病；滋养细胞肿瘤；葡萄胎；宫腔镜 　　[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2018）02（b）-0080-04 　　[Abstract] Objective To study the value of diagnosis and treatment with hysteroscopy for gestational trophoblastic disease. Methods From January 2013 to January 2017， clinical data of 69 patients with GTD were admitted to Department of Gynecologic Oncology， Beijing Obstetrics and Gynecology Hospital， and underwent hysteroscopy was retrospectively analyzed. The and outcome of these patients were reviewed. Results Among these 69 patients， 42 cases were confirmed Hydatidiform moles， 5 cases underwent the first hysteroscopy and curettage， 37 cases underwent hysteroscopy and curettage again. None was residue after curettage. 27 cases were confirmed with GTN including invasive mole in 24 cases， choriocarcinoma in 2 cases， PSTT in 1 case. All the GTN except 1 patient with PSTT achieved complete remission by standard chemotherapy. 1 patient with PSTT was cured by lesion excision. No recurrence was fund in all the GTN patients. Conclusion Selective curettage of residual trohpoblastic tissue directed by hysteroscopy is safe and effective. Hysteroscopy is an effective alternative of diagnosis for GTN， and no effects on the prognosis. 　　[Key words] Gestational trophoblastic disease； Gestational trophoblastic neoplasia； Hydatidiform moles； Hysteroscopes 　　妊娠滋养细胞疾病（gestational trophoblastic disease，GTD）是一组来源于胎盘滋养细胞的疾病，组织学根据形态特征将其分为葡萄胎、侵蚀性葡萄胎、绒毛膜癌及胎盘部位滋养细胞肿瘤（placental site trophoblastic tumor，PSTT）等。其中侵蚀性葡萄胎、绒毛膜癌及PSTT又统称为妊娠滋养细胞肿瘤（gestational trophoblastic neoplasia，GTN）。葡萄胎的首选治疗是吸宫术，葡萄胎再次清宫术很常见。完全性葡萄胎发生子宫局部侵犯和（或）远处转移的率约分