妊娠滋养细胞疾病-.ppt

妊娠滋养细胞疾病;妊娠滋养细胞疾病(gestationaltrophoblasticdisease,GTD)是一组来源于胎盘滋养细胞的疾病，包括(including)：

葡萄胎(hydatidiformmole)

侵蚀性葡萄胎(Invasivemole)

绒毛膜癌(Choriocarcinoma)

胎盘部位滋养细胞肿瘤(placentalsitetrophoblastictumor）;侵蚀性葡萄胎、绒癌和胎盘部位滋养细胞肿瘤，统称为妊娠滋养细胞肿瘤(gestationaltrophoblasticneoplasia,GTN);第一节葡萄胎;一相关因素(pathogenicfactors);一相关因素(pathogenicfactors);一相关因素(pathogenicfactors);一相关因素(pathogenicfactors);二、病理(pathology);Completehydatidiformmole;二、病理(pathology);镜下观(microscopicobservation)可见绒毛体积增大，间质水肿，绒毛内血管消失(thebloodvesselsinvillaaredisappeared)，还可见弥漫性滋养细胞增生(diffuseproliferationoftrophocyte);完全性葡萄胎;Q ;二、病理(pathology);二、病理(pathology);二、病理(pathology);二、病理(pathology);二、病理(pathology);三、临床表现(clinicalmanifestations);三、临床表现(clinicalmanifestations);5.妊娠剧吐(vomitingofpregnancy)

出现时间较正常妊娠早、症状重、持续时间长(the

onsetisearlier,thesymptomismoreserious,the

periodofsymptomislongerthannormalpregnancy);7.卵巢黄素化囊肿(thecaluteinovariancyst)

系大量HCG刺激卵泡内膜细胞(thecainternacells)发生

黄素化而形成的囊肿

多在葡萄胎清除后2-4个月自然消退(spontaneously

disappeared);可有完全性葡萄胎的大多数症状，但程度较轻

(therearegreatmajorityofsymptomsofcomplete

hydatidiformmole,butthedegreeofsymptomsare

slighterthanthecompleteone);四、自然转归(spontaneousend-result);HCG＞100000U/L

子宫体积明显大于相应孕周

(correspondingpregnancyweeks)

卵巢黄素囊肿直径＞6cm（thediameterof

thecaluteinovariancystismorethan6cm)

患者年龄＞40岁

重复性葡萄胎(repeatedhydatidiformmole);首次降至正常的时间约为9周，最长不超过14周

葡萄胎排空后，HCG持续阳性者应考虑妊娠滋养细胞

肿瘤(persistentgestationaltrophoblastictumor）;五、诊断（diagnosis）;辅助检查(accessoryexaminations);六、鉴别诊断(differentialdiagnosis);七、处理(management);3.预防性化疗(preventivechemotherapy);七、处理(management);八、随访(follow-upsurvey);八、随访(follow-upsurvey);随访期必须严格避孕(contraception)1年;第二节妊娠滋养细胞肿瘤

(gestationaltrophoblasticneoplasia,GTN)

;第二节妊娠滋养细胞肿瘤;第二节妊娠滋养细胞肿瘤;侵蚀性葡萄胎吸宫后1月;侵蚀性葡萄胎吸宫后2月，化疗后2周;侵蚀性葡萄胎吸宫后2月，化疗后4周;侵蚀性葡萄胎吸宫后2月，化疗后6周;侵蚀性葡萄胎吸宫后2月，化疗后12周;第二节妊娠滋养细胞肿瘤;第二节妊