Abstract:Objective To study the value of diagnosis and treatment with hysteroscopy for gestational trophoblastic disease. Methods From January 2013 to January 2017, clinical data of 69 patients with GTD were admitted to Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, and underwent hysteroscopy was retrospectively analyzed. The and outcome of these patients were reviewed. Results Among these 69 patients, 42 cases were confirmed Hydatidiform moles, 5 cases underwent the first hysteroscopy and curettage, 37 cases underwent hysteroscopy and curettage again. None was residue after curettage. 27 cases were confirmed with GTN including invasive mole in 24 cases, choriocarcinoma in 2 cases, PSTT in 1 case. All the GTN except 1 patient with PSTT achieved complete remission by standard chemotherapy. 1 patient with PSTT was cured by lesion excision. No recurrence was fund in all the GTN patients. Conclusion Selective curettage of residual trohpoblastic tissue directed by hysteroscopy is safe and effective. Hysteroscopy is an effective alternative of diagnosis for GTN, and no effects on the prognosis.
杨淑丽 吴玉梅 李巍 田明 苗劲蔚▲. 宫腔镜在妊娠滋养细胞疾病诊治中的应用[J]. 中国医药导报, 2018, 15(5): 80-83.
YANG Shuli WU Yumei LI WEI TIAN Ming MIAO Jinwei▲. Application of hysteroscopy in diagnosis and management of gestational trophoblastic disease. 中国医药导报, 2018, 15(5): 80-83.
[1] 马丁,沈铿,崔恒.常见妇科恶性肿瘤诊治指南[M].5版.北京:人民卫生出版社,2016:118-119.
[2] 刘萍,李怀芳.滋养细胞疾病9例误诊分析[J].同济大学学报:医学版,2011:32(3):88-91.
[3] 谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:336.
[4] Cohen SB,Kalter-Ferber A,Weisz BS,et al. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue [J]. J Am Assoc Gynecol Laparosc,2001, 8(2):199-202.
[5] Faivre E,Deffieux X,Mrazguia C,et al. Hysteroscopic management of residual trophoblastic tissue and reproductive outcome:a pilot study [J]. Minim Invasive Gynecol,2009, 16(4):487-490.
[6] Rein DT,Schmidt T,Hess AP,et al. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage [J]. J Minim Invasive Gynecol,2011,18(6):774-778.
[7] Ben-Ami I,Melcer Y,Smorgick N, et al. A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception [J]. Int J Gynaecol Obstet,2014,127(1):86-89.
[8] 顾宇,冯凤芝,向阳,等.腹腔镜和/或宫腔镜在疑诊妊娠滋养细胞肿瘤患者鉴别诊断和治疗中的应用[J].协和医学杂志.2016,7(4):253-258.
[9] 张斌.葡萄胎患者二次清宫应用宫腔镜分析[J].按摩与康复医学,2014,5(8):77-78.
[10] 方莉,丁杰,曾海涛,等.宫腔镜检查在疑诊妊娠滋养细胞肿瘤鉴别诊断中的价值[J].中华妇幼临床医学杂志:电子版,2009,5(4):370-372.
[11] 庞衍平,王硕,王秀艳.彩色多普勒超声对宫角妊娠诊断及鉴别诊断的价值[J].医学影像学杂志,2015,25(6):1052-1054.
[12] 佐满珍,杨慧琼,汪琼.宫腔镜诊治流产清宫后宫内异常回声[J].中国妇幼保健,2008,23(9):1274-1276.
[13] 顾宇,冯凤芝,向阳,等.宫腔镜手术在妊娠滋养细胞肿瘤患者鉴别诊断中的应用研究[J].中国医刊,2015,50(3):42-45.
[14] 朱婷婷,鹿欣.宫腔镜和腹腔镜在妊娠滋养细胞肿瘤诊治中的应用[J].国际妇产科学杂志,2017,44(1):31-34.
[15] Machtinger R,Gotlieb WH,Korach J,et al. Placental site trophoblastic tumor:outcome of five cases including fertility preserving management [J]. Gynecol Oncol,2005, 96(1):56-61.
[16] 石一复.再论宫腔镜及腹腔镜用于妊娠滋养细胞疾病/肿瘤诊治[J].中国计划生育和妇产科,2016,8(10):1-4.
[17] 倪妍,吕卫琴.王稳莹宫腔镜在可疑妊娠滋养细胞疾病中应用[[A].中华医学会第十次全国计划生育学学术会议论文集[C].深圳:2014:292-295.
[18] Bettocchi S,Nappi L,Ceci O,et al. What does 'diagnostic hysteroscopy' mean today? The role of the new techniques [J]. Curr Opin Obstet Gynecol,2003,15(4):303-308.
[19] 袁秀英,刘晓媚,黄丽娥,等.B超监测下宫腔镜电切治疗瘢痕妊娠100例临床分析[J].中国临床医生,2014, 42(3):61-62.
[20] 马洁稚,杨益民,徐大宝,等.滋养细胞肿瘤误诊为宫颈妊娠1例报道[J].肿瘤药学,2016:6(5):398-400.