【摘要】 目的探讨宫腔镜在妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)诊治中的临床价值。方法回顾性分析2010年1月～2016年12月40例拟诊GTN及11例确诊GTN患者的临床资料。通过宫腔镜检查、病灶切除或组织活检、病理明确诊断,进行鉴别诊断和治疗评估。结果在40例拟诊GTN中,病理证实9例GTN,22例妊娠物残留,3例宫角妊娠,4例葡萄胎残留,2例胎盘部位结节(placental site nodule,PSN)。11例确诊GTN中,经宫腔镜评估及病灶切除均通过手术及化疗获得完全缓解(血hCG水平至少持续4周正常)。20例GTN中,1例失访,19例随访1～7年,中位时间3年,无复发。结论在拟诊GTN且前期妊娠不明的情况下,宫腔镜检查可有效鉴别GTN和妊娠相关疾病。对于明确GTN诊断者,适当的宫腔镜干预可切除病灶、减少化疗负荷,并为中间型GTN保留生育功能提供可能。更多还原

【Abstract】 Objective To evaluate the effectiveness of hysteroscopy on the diagnosis and management of gestational trophoblastic neoplasia( GTN). Methods From January 2010 to December 2016,a total of 51 patients with a suspected diagnosis( 40 cases) or a confirmed diagnosis( 11 cases) of GTN were admitted to our hospital. All the patients had undergone hysteroscopy exploration,lesion resection or biopsy,and pathological examination for differential diagnosis and management evaluation. Results Of the 40 cases with suspected GTN,final histology confirmation showed 9 cases of GTN,22 cases of intrauterine residual pregnancy tissue,3 cases of cornual pregnancy,4 cases of hydatidiform mole,and 2 cases of placental site nodule( PSN). The 11 confirmed GTN cases were examined and further treated by hysteroscopy,so as to effectively salvage some patients with isolated foci,and then a complete remission( h CG level returned to normal for at least 4 weeks) was achieved through surgery and chemotherapy. Except for 1 case of lost to follow-up,the remaining 19 cases of GTN were followed up for 1-7 years( median,3 years). No evidence of recurrent disease was noted. Conclusions To diagnose the suspected GTN patients,hysteroscopy with biopsy or resection can make a definitive diagnosis. For confirmed GTN cases,appropriate hysteroscopy can resect the lesion,relieve the side effects of chemotherapy,and make it possible to preserve fertility for the younger patient with intermediate trophoblastic diseases.更多还原