双胎妊娠合并部分性葡萄胎胎儿存活产后肺转移一例  

Twin pregnancy complicated with partial hydatidiform mole metastasizing to the lung: a case report

作　　者：侯东升[1] 孙茜[2] 杨兴升[1] 刘颖[1] 刘冉[1] 罗霞[1] 

机构地区：[1]山东大学齐鲁医院妇产科,济南250012 [2]济南市妇幼保健院妇产科,济南250001

出　　处：《新医学》2016年第2期134-136,共3页Journal of New Medicine

摘　　要：妊娠合并部分性葡萄胎较为少见,且一般不发生转移。该文报道了一例双胎妊娠合并部分性葡萄胎胎儿存活产后肺转移患者的诊治经过。该例患者为双胎妊娠,在妊娠期间无临床症状,因胎膜早破行剖宫产术,术中发现宫腔内子宫后壁处有一内容物。术后经胎盘及内容物病理检查证实为双卵双胎,其一为正常胎儿,另一为部分性葡萄胎与胎儿共存。术后随访发现患者人绒毛膜促性腺激素(h CG)上升较快,胸部X线片示右肺中野异常密度,诊断为侵蚀性葡萄胎(肺转移)。经过3个疗程化学治疗后,患者h CG下降,肺部病灶缩小。该例患者的诊治过程提示,部分性葡萄胎临床表现无特异性,对于产时才发现葡萄胎且h CG上升较快者应警惕其出现远处转移,及早行化学治疗有助于改善预后。Twin pregnancy complicated with partial hydatidiform mole is seldom encountered and the metastasis of hydatidiform mole is rarely seen. In this article,the diagnosis and treatment of one woman of twin pregnancy complicated with partial hydatidiform mole metastasizing to the lung were reported. The patient had twin pregnancy and presented with no clinical symptoms during pregnancy. She underwent cesarean section due to premature rupture of membranes. Intraoperatively,a mass was observed in the uterine cavity of the posterior wall of uterus. Postoperative pathological examination of the placenta and contents detected a twin pregnancy consisting of a partial hydatidiform mole and coexisting fetus. Postoperative follow-up found that the human chorionic gonadotropin（ hCG） level was rapidly elevated. Chest X-ray revealed abnormal density in the middle field of right lung lobe,which was diagnosed as invasive hydatidiform mole（ metastasizing to lung）. After three courses of chemotherapy,the hCG level was decreased and the pulmonary lesion was reduced in size. The diagnosis and treatment of this case hinted that patients with partial hydatidiform mole presented with no specific clinical manifestations. The risk of distal metastasis should be cautioned for those with hydatidiform mole found upon birth delivery and rapid elevation of hCG. Chemotherapy should be performed early to enhance clinical prognosis.

关 键 词：双胎 部分性葡萄胎 侵蚀性葡萄胎 

分 类 号：R737.33[医药卫生—肿瘤]