葡萄胎与胎儿共存的早期超声诊断  

Early ultrasonic diagnosis of hydatidiform mole with coexistent live fetus

作　　者：陈欣 李雷[2] 罗红 Xin Chen;Lei Li;Hong Luo(Department of Ultrasound/Key Laboratory of Birth Defects and Related Diseases of Women and Children,Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of Pathology,West China Second University Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院超声科/出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [2]四川大学华西第二医院病理科,成都610041

出　　处：《中华医学超声杂志（电子版）》2023年第11期1150-1157,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：四川省科技厅重点研发项目(2022YES0086);成都市科技局(2021-YF05-02096-SN)。

摘　　要：目的探讨双胎之一完全性葡萄胎(CHMCF)、部分性葡萄胎合并胎儿存活(PHMF)的超声图像诊断与鉴别诊断要点,提高诊断正确率,为临床处理提供依据。方法回顾2016年1月至2021年6月于四川大学华西第二医院诊治,并经病理证实为葡萄胎与胎儿共存的16例病例,其中CHMCF 7例,PHMF 9例,对其临床表现、超声诊断孕周、超声图像特征及预后进行分析。结果CHMCF的所有孕妇均有阴道出血症状,而PHMF仅有3例孕妇有阴道出血。孕早期(孕6~10周)两者的超声图像并未表现为典型的葡萄样水泡状回声,但所有CHMCF病例的孕囊旁均可见无回声、絮状稍强回声、杂乱回声或似另一孕囊的异常回声。孕11周后,CHMCF病例的葡萄样水泡状回声较局限,多与胎盘间分界较清楚,或与正常胎儿间可见隔膜样回声。PHMF病例的葡萄样水泡回声多位于胎盘内,散在分布或几乎占据整个胎盘。16例中仅有1例CHMCF患者在行染色体检查后继续妊娠至足月分娩,余因阴道持续出血、咯血或患者不愿继续妊娠等原因行引产术。有1例PHMF病例发展为滋养细胞肿瘤(GTN),余病例随访12个月均未发现GTN。结论孕6~10周CHMCF与PHMF的超声图像表现不典型,很难做出诊断。孕11周后,可根据葡萄状水泡回声的位置、与胎盘关系及与存活胎儿间是否有隔膜样回声对两者进行诊断和鉴别诊断,为临床处理提供依据。Objective To investigate the ultrasonoimagedata diagnosis and differential diagnosis of twin pregnancy with one complete hydatidiform mole and coexistent live fetus(CHMCF)and partial hydatidiform mole with live fetus(PHMF),so as to improve the diagnostic accuracy and provide a basis for clinical management of this condition.Methods Sixteen cases of hydatidiform mole with coexistent live fetus were diagnosed and treated at West China Second University Hospital from January 2016 to June 2021,including 7 cases of CHMCF and 9 cases of PHMF.The clinical manifestations,gestational weeks at ultrasonic diagnosis,ultrasonoimagedata features,and prognosis were analyzed.Results All pregnant women with CHMCF had vaginal bleeding,while only 3 pregnant women with PHMF had vaginal bleeding.There was no typical grape-like vesicular echo in the ultrasound images in early pregnancy(6-10 weeks),but no echo,flocculent echo,disorderly echo,or abnormal echo like another gestational sac could be seen near the gestational sac in all CHMCF cases.At 11 weeks of pregnancy,in the cases of CHMCF,the grape-like vesicular echo was limited,and the boundary between the grape-like vesicular echo and the placenta was clear,or the diaphragm-like echo could be seen between the grape-like vesicular echo and the normal fetus.In the case of PHMF,the grape-like vesicular echo was mostly located in the placenta,scattered,or almost occupied the whole placenta.Of all 13 cases of CHMCF,only one patient continued pregnancy to full-term delivery after chromosome examination,and the rest underwent induced labor because of continuous vaginal bleeding,hemoptysis,patient's unwillingness to continue pregnancy,and so on.One case of PHMF developed into gestational trophoblastic neoplasia(GTN),and no GTN or distant metastasis was found in the remaining 12 months of follow-up.Conclusion From 6 to 10 weeks of gestation,the ultrasonoimagedata findings of CHMCF and PHMF are not typical,so it is difficult to make a diagnosis.After 11 weeks of pregnancy,a diagnosis or diff

关 键 词：葡萄胎 胎儿 共存 超声诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]