宫腔镜诊治中间型滋养叶细胞病变的临床价值  

Diagnosis and treatment of intermediate trophoblast lesions with hysteroscopy

作　　者：穆玉兰[1] 王飞[1] 石敏[1] 刘鸣[1] 

机构地区：[1]山东大学附属省立医院妇产科,山东济南250021

出　　处：《中国内镜杂志》2010年第11期1129-1133,1136,共6页China Journal of Endoscopy

基　　金：山东省中青年科学家科研奖励基金支持(No:2008BSB14059)

摘　　要：目的探讨宫腔镜在诊治中间型滋养叶细胞病变(LIT)方面的临床价值。方法 2003年6月至～2008年6月通过宫腔镜检查LIT5例,实施宫腔镜电切治疗PSTT1例,EPS和PSN各1例,诊治前血β-HCG14.78～1720mIU/mL(正常值0～1mIU/mL)。B超显示包块最小者2.9cm×2.0cm×3.4cm,最大者5.8cm×4.6cm×5.6cm,彩色多普勒血流显像(CDFI)可见点状血流信号者1例,余不丰富。结果 5例中通过宫腔镜检查确诊的LIT病变4例,其中PSTT2例,EPS和PSN各1例。3例宫腔镜电切术在B超严密监护下均顺利完成,无并发症,未输血。1例实施"子宫+双侧附件切除术",放弃手术者1例。4例手术者于术后7d查β-HCG正常者3例。5例中1例失访,保留子宫者月经基本恢复正常。结论宫腔镜查并活检可以提高LIT的诊断率,而宫腔镜电切手术对于病变局限、希望保留生育功能的年轻妇女具有重要的临床价值,并可以达到完全消除病灶的良好临床效果。【Objective】To discuss the clinical significance of hysteroscopy in diagnosis and treatment of lesions of intermediate trophoblast （LIT）.【Methods】From June,2003 to July,2008,5 cases of LIT were examined with hysteroscopy and 3 cases of those were operated with transcervical resection under hysteroscopy,including 1 case of placental site trophoblastic tumor （PSTT）,1 case of placental site nodule （PSN） and 1 case of exaggerated placental site （EPS）.Before diagnosis and treatments,serum levels of human chorionic gonadotropin （HCG） was from 14.78 mIU/mL to 1720 mIU/mL （normal value：0～1 mIU/mL） and uterus mass demonstrated by ultrasonograph images were from 2.9 cm × 2.0 cm × 3.4 cm to 5.8 cm × 4.6 cm × 5.6 cm.Color Doppler Flow imaging system revealed that only 1 case had the signature of spot blood flow.【Results】Among the above mentioned 5 cases,there were four cases which had been made the correct diagnosis with hysteroscopy and three of them were smoothly operated with transcervical resection through hysteroscopy which were monitored by ultrasonograph with neither subsequent syndrome nor blood transfusion.Of those other 2 cases,1 case was implemented the operation of panhysterosalpingo oophorecctomy and the other had abandoned the operation.Seven days after operations,3 cases of the four who had been carried out the operations had the serum HCG level recovered to the normal level.In the total 5 cases,the contact to 1 case was broken and the other 4 follow-up surveys displayed that the patients＇ menses were almost recovered as the uterus had been reserved.【Conclusions】Hysteroscopy with biopsy can improve the diagnosis accuracy rate for LIT.The transcervical resection under hysteroscopy is a very useful method in treating LIT and it has evident effects,little trauma and few complication,especially for those younger women whose lesions is limitedly localized and have the strong desire to future fertility.

关 键 词：中间型滋养叶细胞病变 宫腔镜检查术 宫腔镜电切术 

分 类 号：R737[医药卫生—肿瘤]