葡萄胎集中化管理临床意义的探讨  

Clinical significance of centralized surveillance of hydatidiform mole

作　　者：焦澜舟 王亚萍[2] 姜继勇[1] 张文清 王秀莹 朱成功[1] 张译文[1] Jiao Lanzhou;Wang Yaping;Jiang Jiyong;Zhang Wenqing;Wang Xiuying;Zhu Chenggong;Zhang Yiwen(Department of Gynecology Oneology,Dalian Maternal and Child Health Care Hospital,Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University,Dalian 116033,China)

机构地区：[1]大连市妇幼保健院暨大连医科大学附属妇产医院妇科肿瘤诊疗中心,116033 [2]大连市妇幼保健院暨大连医科大学附属妇产医院病理科,116033

出　　处：《中华妇产科杂志》2018年第6期390-395,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨葡萄胎集中化管理的临床意义。方法收集2013年2月—2017年2月在大连市妇幼保健院行第1次清宫术并经病理检查确诊的所有葡萄胎患者，无论是否存在葡萄胎恶变的高危因素，均未行预防性化疗，直接纳入葡萄胎集中化管理。葡萄胎恶变的高危因素包括：年龄〉40岁，子宫明显大于孕周（即指超过正常孕周4周），血清hCG水平〉5×105 U/L，卵巢黄素化囊肿直径〉6 cm，重复性葡萄胎。葡萄胎集中化管理包括：从病理报告的集中管理着手，加强诊治团队（包括妊娠滋养细胞疾病门诊、肿瘤病房、检验科、病理科和遗传实验室）的合作，并对患者进行科普宣教和心理支持。本研究回顾性分析纳入葡萄胎集中化管理患者的随诊结果及治疗结局。结果本研究共有407例患者纳入葡萄胎集中化管理，其中有恶变高危因素的葡萄胎患者70例。葡萄胎患者的随诊率达97.5%（397/407），总恶变率为8.1%（32/397），其中有恶变高危因素和无恶变高危因素的葡萄胎患者的恶变率分别为22.9%（16/70）、4.9%（16/327），两者比较，差异有统计学意义（χ2=25.108，P〈0.01）。32例葡萄胎恶变患者均为国际妇产科联盟（FIGO，2000年）预后评分低危患者（即评分为0~6分者），其中1例患者行子宫全切除术、31例患者化疗，治疗后的临床完全缓解率为100.0%（32/32）。31例化疗患者中，30例初次化疗采用单药化疗，其中18例（60.0%，18/30）达完全缓解。32例葡萄胎恶变患者中，有恶变高危因素和无恶变高危因素的患者各有16例，两者的妊娠终止至化疗开始的间隔时间、治疗前血清hCG水平、临床分期和FIGO预后评分分别比较，差异均无统计学意义（P〉0.05）。结论具有恶变高危因素的葡萄胎患者的恶变风险增高，但若恶变患者得到及时的诊治，并不影响其预后。有恶变高危因素的葡萄胎ObjectiveTo explore the clinical significance of centralized surveillance of hydatidiform mole.MethodsFrom Feb. 2013 to Feb. 2017 all patients with hydatidiform mole, who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital, were registered centrally for serum hCG monitoring and treatment if necessary. Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole. The risk factors included age of over 40 years, excessive uterine enlargement for presumed gestational age, a serum hCG level greater than 5 00 000 U/L, large theca lutein ovarian cysts （〉6 cm）, and a history of previous hydatidiform mole. The centralized surveillance of hydatidiform mole was based on the central pathology review, team cooperation and service improvement. Their treatments and outcomes were analyzed retrospectively.ResultsA total of 407 women of hydatidiform mole were registered with histopathology confirmation, including 70 high-risk hydatidiform moles. The follow-up rate was 97.5% （397/407） . The incidence of post-mole neoplasia was 8.1% （32/397） , which was diagnosed in 22.9% （16/70） of high-risk and in 4.9% （16/327） of low-risk hydatidiform moles, showed statistically significant difference between high-risk and low-risk groups （χ2=25.108, P〈0.01） . Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics （FIGO） score （range, 0-6） and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy. The primary cure rate of single-agent chemotherapy was 60.0% （18/30） . Patients with low-risk or high-risk post-mole neoplasia were both 16. There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment, the serum level of hCG before treatment, clinical stage or risk factor score （all P〉0.05） .Conclusi

关 键 词：葡萄胎 疾病管理 肿瘤治疗方案 维持化疗 随访研究 

分 类 号：R737.33[医药卫生—肿瘤]