输卵管完全性葡萄胎误诊临床病理分析并文献复习  

Misdiagnosis of Complete Hydatidiform Mole in Fallopian Tube: Clinical Pathological Analysis and Literature Review

作　　者：罗莹[1] 王成有[1] 吴荔香[1] 祝建芳[1] LUO Ying;WANG Cheng-you;WU Li-xiang;ZHU Jian-fang(Department of Pathology,Fujian Provincial Maternity and Children's Hospital Affiliated Hospital of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院福建医科大学附属医院病理科,福州350001

出　　处：《临床误诊误治》2020年第5期8-12,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨输卵管完全性葡萄胎临床及病理特征、诊治方法、误诊原因、误诊防范措施。方法对2例曾误诊的输卵管完全性葡萄胎的临床资料进行回顾性分析并复习相关文献。结果本文1例因停经2月余,阴道出血6 d入院。查血β人绒毛膜促性腺激素(β-HCG)17 229.3 U/L。术前误诊为异位妊娠,行输卵管切除术。1例因阴道不规律出血1月余,下腹闷痛2周,加剧5 d入院。无明确停经史。查血β-HCG 84 140.0 U/L。术前考虑盆腔炎性包块,卵巢囊肿蒂扭转,异位妊娠。行开腹右输卵管切除、左输卵管结扎及诊断性刮宫术。2例均经术后病理检查确诊为输卵管完全性葡萄胎,皆随访2年,无异常发现。结论输卵管葡萄胎较少见,临床易误诊。临床医生应提高对本病的认识,在遇到类似异位妊娠表现患者时应想到异位葡萄胎的可能性,要综合全面对患者病情进行分析,并仔细鉴别诊断,以减少误诊误治。Objective To study the clinicopathologic features, diagnosis and therapeutic methods, the causes of misdiagnosis, and prevention of complete hydatidiform mole in fallopian tube. Methods The clinical data of two cases of complete hydatidiform mole in fallopian tube misdiagnosed were retrospectively analyzed, and relevant literature was reviewed. Results One patient was admitted to our hospital due to amenorrhea for more than 2 months and vaginal bleeding for 6 days. Blood β human chorionic gonadotropin(β-HCG) level was 17 229.3 U/L. She was misdiagnosed with ectopic pregnancy preoperatively and the salpingectomy was performed. The other patient was admitted to the hospital due to irregular vaginal bleeding for more than 1 month, lower abdominal dull pain for 2 weeks which was worsened for 5 days, and there was no history of amenorrhea. Blood β-HCG level was 84 140.0 U/L, and she was initially diagnosed with pelvic inflammatory mass, torsion of the pedicle of ovarian cyst and ectopic pregnancy preoperatively. The right salpingectomy, left tubal ligation and diagnostic curettage were performed. Two cases were both definitely diagnosed as complete hydatidiform mole in fallopian tube by postoperative pathology. They were followed up for 2 years without any abnormality. Conclusion The occurrence of hydatidiform mole in fallopian tube is rare, and it is easily misdiagnosed by clinicians. Clinicians need to better understand this disease and take ectopic hydatidiform mole into account for patients with clinical symptom similar to ectopic pregnancy. Therefore, to decrease misdiagnosis and mistreatment, it is necessary to comprehensively analyze the patients’ condition and pay attention to differential diagnosis.

关 键 词：葡萄胎 输卵管 误诊 妊娠 异位 盆腔炎性疾病 卵巢囊肿 

分 类 号：R737.33[医药卫生—肿瘤]