双胎合并部分性葡萄胎剖宫产术后继发绒癌一例的病例分析报告

发布时间：2018-03-06 09:39

本文选题：双胎　切入点：部分性葡萄胎　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景：妊娠合并葡萄胎在临床上较为少见。它可分为完全性葡萄胎和部分性葡萄胎合并一个胎儿两种类型,其中以完全性葡萄胎合并一个胎儿为主,胎儿存活几率高,发展为持续滋养细胞疾病的几率高；部分性葡萄胎胎儿通常在妊娠早期死亡,罕有活胎能生存到妊娠中、晚期,发展为持续滋养细胞疾病的几率稍低。目的：探讨葡萄胎与胎儿共存的可能的发病原因、组织病理特点、临床表现、妊娠结局及产前诊断-主要是依靠超声、病理和染色体核型分析在诊断部分性葡萄胎中的作用,有利于指导产科医师在临床中对此类患者进行全面的孕期及产后评估,保证孕妇及新生儿的健康。方法：总结2012年我院收治的一例双胎妊娠,部分性葡萄胎与胎儿共存剖宫产术后继发绒癌患者的治疗经过及随访结果,将其临床资料作以详细报导。结果：患者因“胎膜早破、胎儿窘迫”剖宫产娩两名正常的早产女婴。术中见：子宫后壁见大小不等的水泡样组织与长女胎盘相续,术后胎盘病理诊断为部分性葡萄胎。术后HCG持续上升且影像学检查示肺转移,诊断为侵蚀性葡萄胎,由产科转入妇科进行治疗。经化疗后,血HCG降至正常,效果满意。随访1年后,两女婴外观未见明显异常,智力评估检查未见明显差异。但患者出现停经症状,查血HCG升高,再次收入院,排除妊娠后,考虑妊娠滋养细胞疾病复发,最后患者行子宫切除术,术后病理诊断为绒毛膜癌,术后予以化疗。现生命体征平稳,仍在严密随访。结论：妊娠合并部分性葡萄胎且胎儿存活极为少见。对于此类患者,产前明确诊断,尤其是彩超、病理及染色体核型分析,对于决定是否继续妊娠和判断预后十分重要。妊娠合并葡萄胎患者常常需要产科与妇科医师的密切配合进行诊治,多数患者预后良好。
[Abstract]:Background: pregnancy with hydatidiform mole is rare in clinic. It can be divided into two types: complete mole and partial mole combined with one fetus. The risk of developing persistent trophoblastic disease is high; partial hydatidiform mole usually dies at the early stage of pregnancy, few live fetus can survive to pregnancy, and later stage, the probability of developing persistent trophoblastic disease is lower. Objective: to investigate the possible pathogenesis, histopathological features, clinical manifestations, pregnancy outcome and prenatal diagnosis of hydatidiform mole coexisting with fetus, which mainly rely on ultrasound, pathology and karyotype analysis in the diagnosis of partial hydatidiform mole. It is helpful to instruct obstetricians to make comprehensive evaluation of such patients during pregnancy and postpartum, and to ensure the health of pregnant women and newborns. Methods: in 2012, a case of twin pregnancy, partial hydatidiform mole and fetal coexisting cesarean section secondary choriocarcinoma treatment and follow-up results were summarized, and the clinical data were reported in detail. Results: due to premature rupture of membranes and fetal distress, two normal preterm female infants were delivered by cesarean section. The pathological diagnosis of placenta after operation was partial hydatidiform mole. After operation, HCG continued to rise and imaging examination showed pulmonary metastasis. It was diagnosed as invasive hydatidiform mole and transferred from obstetrics to gynecology for treatment. After chemotherapy, the blood HCG decreased to normal. The results were satisfactory. After one year of follow-up, there was no obvious abnormality in appearance and no significant difference in intelligence assessment between the two female infants. However, the patient appeared menopause symptoms, blood HCG increased, and was admitted to hospital again, excluding pregnancy, taking into account the recurrence of gestational trophoblastic disease. Finally, the patient underwent hysterectomy, postoperative pathological diagnosis of choriocarcinoma, postoperative chemotherapy. Conclusion: pregnancy with partial hydatidiform mole and fetal survival is very rare. For such patients, prenatal diagnosis is definite, especially color Doppler ultrasound, pathology and karyotype analysis. It is very important to decide whether to continue pregnancy and to judge the prognosis. Patients with pregnancy complicated with hydatidiform mole often need close cooperation between obstetrics and gynecologist for diagnosis and treatment. Most patients have a good prognosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【参考文献】