【摘要】 目的探讨手术在妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)中的诊治意义,比较不同手术方式间差异。方法回顾性分析2016年1月至2018年12月在复旦大学附属妇产科医院疑诊GTN并接受手术治疗的76例患者临床病理资料,分析不同手术方式对诊断、疗效、预后的影响及超声检查发挥的辅助作用。结果76例患者术后诊断GTN共60例(侵蚀性葡萄胎23例,绒癌17例,胎盘部位滋养细胞肿瘤10例,临床诊断10例),妊娠物残留或宫角妊娠10例,葡萄胎5例,静息性妊娠滋养细胞疾病1例。病灶切除与全子宫切除者在出血及术后恢复、辅助化疗次数等方面比较无明显差异。除1例患者因化疗引发间质性肺炎而死亡,余均通过手术或联合化疗获得完全缓解或部分缓解。结论血β-hCG及超声评估对选择手术方式、协助确定病灶及预计术中出血有一定帮助。手术对明确GTN病理诊断有重要意义,当出现化疗耐药、副反应不耐受,病灶持续存在等情况,应结合超声评估及血β-hCG,考虑手术治疗。更多还原

【Abstract】 Objective To investigate the effectiveness of surgery in the diagnosis and treatment of gestational trophoblastic neoplasia(GTN),and compare the differences among surgical approaches and procedures.Methods From January 2016 to December 2018,76 patients with suspected diagnosis of GTN were admitted to and underwent surgery in Obstetrics and Gynecology Hospital of Fudan University.The clinical and pathological data was analyzed retrospectively for influence of surgery on diagnosis,efficacy and prognosis,and the assistant role ultrasound plays.Results Among the 76 patients,60 were diagnosed with GTN(23 cases of invasive hydatidiform mole,17 cases of choriocarcinoma,10 cases of placental site trophoblastic neoplasia,10 cases of clinical diagnosis),10 cases of gestational residues or cornual pregnancy,5 cases of hydatidiform mole and 1 case of silent gestational trophoblastic disease.There was no significant difference between lesion removal and hysterectomy in bleeding,recovery or times of adjuvant chemotherapy.Except one patient who died of interstitial pneumonia caused by chemotherapy,all patients achieved complete remission or partial remission by surgery or subsequent chemotherapy.Conclusion Blood β-hCG and ultrasound assessment help to some extent to determine surgery procedures,confirm lesions and estimate blood loss.Surgery is meaningful in defining the pathological diagnosis of GTN.When the conditions occur,including chemoresistance,intolerant side effects and persistent lesions,surgery treatment should be considered based on ultrasound assessment and β-hCG.更多还原