协和医学杂志

2016, v.7(04) 253-258

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腹腔镜和/或宫腔镜在疑诊妊娠滋养细胞肿瘤患者鉴别诊断和治疗中的应用
Laparoscopy and/or Hysteroscopy in Differential Diagnosis and Treatment of Suspected Gestational Trophoblastic Neoplasia

顾宇;冯凤芝;向阳;万希润;任彤;杨隽钧;
GU Yu;FENG Feng-zhi;XIANG Yang;WAN Xi-run;REN Tong;YANG Jun-jun;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的探讨腹腔镜和/或宫腔镜手术对于疑诊妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)的鉴别诊断和治疗价值及对其结局的影响。方法回顾性分析北京协和医院妇产科2005年1月至2013年12月收治的160例疑诊GTN而行腹腔镜和/或宫腔镜手术患者的临床资料,分析患者的诊断和结局。结果 160例患者中有26例诊断为GTN,包括15例绒毛膜癌、6例侵蚀性葡萄胎和5例胎盘部位滋养细胞肿瘤;134例诊断为非GTN疾病,包括妊娠物残留106例(51例不全流产、52例宫角妊娠残留、2例胎盘残留、1例葡萄胎残留),剖宫产瘢痕部位妊娠23例,宫角妊娠3例,子宫肌壁间妊娠2例。除末次妊娠性质(P<0.001)外,GTN患者与非GTN患者之间的大部分临床资料差异无统计学意义。除1例患者治疗中失访外,其他所有GTN和非GTN患者最终均通过手术或联合化疗获完全缓解或治愈。结论根据患者临床资料难以鉴别GTN时,通过腹腔镜和/或宫腔镜手术有助于明确诊断,手术对GTN患者结局无明显影响,同时可以对非GTN疾病进行有效治疗。
Objective To investigate the application of laparoscopy and/or hysteroscopy in differential diagnosis and treatment of suspected gestational trophoblastic neoplasia( GTN),and its potential impact on outcome. Methods From January 2005 to December 2013,160 patients with a suspected diagnosis of GTN were admitted to Peking Union Medical College Hospital and underwent laparoscopy and / or hysteroscopy for it. The clinical data,diagnosis,and outcome of these patients were retrospectively analyzed. Results Among the 160 eligible patients,26 were confirmed with GTN,including choriocarcinoma in 15 cases,invasive mole in 6 cases,and placental site trophoblastic tumor( PSTT) in 5 cases. The diagnosis of GTN was ruled out in the other 134 cases,including intrauterine gestational residues in 106( 51 cases of incomplete abortion,52 cases of residues of cornual pregnancy,2 cases of placental remnants,1 case of residual hydatidiform mole),cesarean scar pregnancyin 23,cornual pregnancy in 3,intramural pregnancy in 2. There was no significant difference in most of the clinical data between GTN patients and non-GTN patients except for the type of last pregnancy( P < 0. 001). All of the GTN and the non-GTN patients achieved complete remission or cure by subsequent chemotherapy or surgical therapy except one patient lost to follow-up during the course of the treatment. Conclusions Laparoscopy and / or hysteroscopy could be an effective strategy to facilitate diagnosis when it is difficult to differentiate GTN from nonGTN diseases by clinical data. Furthermore,that technique would not affect the outcome for GTN patients,while for non-GTN patients they could offer effective treatment.

关键词(KeyWords): 妊娠滋养细胞肿瘤;腹腔镜;宫腔镜;诊断
gestational trophoblastic neoplasia;laparoscopy;hysteroscopy;diagnosis

Abstract:

Keywords:

基金项目(Foundation): 基金项目:首都临床特色应用研究(Z131107002213173)

作者(Author): 顾宇;冯凤芝;向阳;万希润;任彤;杨隽钧;
GU Yu;FENG Feng-zhi;XIANG Yang;WAN Xi-run;REN Tong;YANG Jun-jun;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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