经宫腹腔镜诊断的妊娠滋养细胞肿瘤预后分析  

The Prognosis of Gestational Trophoblastic Neoplasia Diagnosed by Hysteroscopy and Laparoscopy

作　　者：楼伟珍[1] 冯凤芝[1] 向阳[1] 万希润[1] 

机构地区：[1]中国医学科学院北京协和医科大学北京协和医院,北京100730

出　　处：《实用妇产科杂志》2011年第1期28-30,共3页Journal of Practical Obstetrics and Gynecology

基　　金：国家科技支撑计划课题基金(编号:2008BAI57B05)

摘　　要：目的:初步探讨宫腹腔镜用于妊娠滋养细胞肿瘤(GTN)诊断的安全性和对肿瘤预后的影响。方法:回顾性分析经宫腹腔镜诊断为GTN的11例病例资料,其中绒毛膜癌9例,胎盘部位滋养细胞肿瘤2例。结果:11例中行宫腔镜下清宫或病灶切除2例,腹腔镜下病灶切除术9例。手术平均时间48.2±32.4分钟(15～120分钟),中位出血量30ml(5～800ml),无术中和术后并发症。术后1例采用腹腔镜手术治疗,10例接受以氟尿嘧啶为主的联合化疗3～6疗程,平均4.4±1.0疗程,血清β-HCG下降至正常水平平均需化疗2.0±0.8疗程(1～3疗程),其中3例联合经腹手术治疗。所有病例均获得完全缓解,平均随诊31.3±18.7月(3～56月),均无瘤存活。结论:对于临床特征不典型的GTN病例,宫腔镜和(或)腹腔镜检查是可供选择且安全的诊断方法,对预后无不利影响。Objective：To analyze the safety and impact of hysteroscopy and laparoscopy on the diagnosis of gestational trophoblastic neoplasia （GTN）. Methods：Eleven GTN patients who were diagnosed by hysteroscopy and/or laparoscopy in Peking Union Medical College Hospital from January 2005 to December 2009 were recruited.. Nine of them were choriocarcinoma,and the others were placental site trophoblastic tumor. Clinical data were reviewed retrospectively. Results：Two patients underwent hysteroscopy and evacuation, and nine patients were diagnosed and treated by laparoscopy. The mean operating time was 48.2±32.4 min（15-120 min）. The median blood loss was 30 ml （5 -800 ml）. There were no peri-operative complications. After the hysteroscopy or laparoscopy,one patient had surgery,ten patients received 5-Fu based multidrug chemotherapy and achieved complete remission. The level of serum β-hCG declined to normal after 2.0±0.8 cycles（1-3 cycle） of chemotherapy. The mean cycles of chemotherapy were 4.4±1.0 （3-6 cycle）. All the patients were alive and had no evidence of recurrent disease during follow up. The mean duration of follow up was 31.3±18.7 months. Conclusions： Hysteroscopy and laparoscopy are safe alternative diagnostic methods for untypical GTN, and no adverse impact on prognosis.

关 键 词：妊娠滋养细胞肿瘤 腹腔镜 腹腔镜 

分 类 号：R737.3[医药卫生—肿瘤]