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妇产科妊娠滋养细胞疾病.ppt 36页

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-- irregular vaginal bleeding -- vaginal secretion -- abdominal pain -- pelvic mass -- metastasis manifestation Diagnosis laboratory examination: -- HCG continues high level or elevation -- ultrasound, X-ray, CT -- histology:amount of trophocytes and bleeding necrosis, no villus structure Clinical stage(FIGO 2000) Stage I confined to uterus Stage II extending outside of the uterus but limited to the genital structures (adnexa, vagina, broad ligaments) Stage III extending to the lung, with or without genital tract involvement Stage IV all other metastatic sites chemotherapy is the first selection. 5-Fu KSM MTX CTX VCR VP16 Operation:hysterectomy, pneumonectomy Radiotherapy Tratment 1. first time: 3 months after hospital discharge 2. half a year for 3 years 3. once a year for 2 years 4. Contraception Follow up 本章要点 三类滋养细胞疾病的镜下表现 葡萄胎的临床表现、治疗 葡萄胎的随访 HCG在滋养细胞疾病中地位 GTN的转移途径及治疗 Gestational trophoblastic Disease GTD 妊娠滋养细胞疾病 医院妇产科 葡萄胎 (hydatidiform mole) 侵蚀性葡萄胎 (invasive mole) 绒毛膜癌 (choriocarcinoma) 胎盘部位滋养细胞肿瘤 (placental site trophoblastic tumor, PSTT) 葡萄胎 60%,流产 30%、足月妊娠+异位妊娠 10% 10%-20% 妊娠滋养细胞疾病 (gestational trophoblastic disease, GTD) 妊娠滋养细胞肿瘤 (gestational trophoblastic neoplasia,GTN) 临床分类 组织学分类 Hydatidiform Mole [Definition] an abnormal pregnancy characterized grossly by multiple grapelike vesicles filling and distending the uterus , proliferation of syncytiotrophoblastic or cytotrophoblastic element, edema of the villous stroma. [Classification]      complete hydatidiform mole, CHM (more common)      partial hydatidiform mole, PHM AII are benign disease. Hydatidiform Mole Epidemiology The incidence varies greatly between different parts of the world. The incidence from Europe and North America is significantly lower than Asia and South America. morbidity: 290/100,000 0.78/1000 pregnancy in our country High risk: < 20 years of age, or > 40 years old Lack of carotine and animal fat Etiol

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