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目的探讨官腔镜和腹腔镜用于妊娠滋养细胞肿瘤(GTN)鉴别诊断中的价值。方法回顾性分析北京协和医院2003年9月至2006年3月收治的外院疑诊为 GTN 或外院诊断为 GTN 并已接受化疗、转入北京协和医院后因不能确诊而进行宫腔镜和(或)腹腔镜检查及治疗的27例患者的临床资料,并分析官腔镜和腹腔镜在 GTN、不全流产和异位妊娠鉴别诊断中的价值。27例患者,年龄为24～46岁,平均年龄(36±7)岁;主要表现为清宫术后(53±37)d 仍有反复阴道流血;血清人绒毛膜促性腺激素β亚单位(β-hCG)水平异常(3.6～112 469.0 U/L),中位数为235.5 U/L;超声检查提示官腔、一侧宫底或子宫肌层内有占位性病变,其病变内或子宫肌层见丰富的血流;肺部 CT 或胸部 X 线检查无异常发现。官腔镜下清官术11例;腹腔镜检查和手术治疗10例;宫腔镜联合腹腔镜检查及治疗6例。结果最终诊断只有4例患者为 GTN,且均为绒毛膜癌;23例为非 GTN 疾病,包括子宫角妊娠12例、子宫残角妊娠1例和不全流产10例。23例非 GTN 患者,通过官腔镜或腹腔镜手术治疗或术后辅助单次甲氨蝶呤肌内注射,均于术后6周内治愈;4例 GTN 患者,经过以氟尿嘧啶为主的化疗后,均获得完全缓解。结论妊娠终止后阴道异常流血的主要原因有不全流产、异位妊娠和GTN。当通过临床病史、超声检查和血清β-hCG 水平检测等综合分析,仍不能明确诊断时,官腔镜和(或)腹腔镜检查是可供选择的诊断方法,并能同时进行有效的手术治疗。
Objective To investigate the value of endoscopy and laparoscopy in the differential diagnosis of gestational trophoblastic tumor (GTN). Methods Retrospective analysis of the hospital from September 2003 to March 2006 Peking Union Medical College Hospital were diagnosed as GTN or GTN or were diagnosed as GTN and have received chemotherapy, transferred to Peking Union Medical College Hospital for hysteroscopy and (or ) Laparoscopy and treatment of 27 patients with clinical data and analysis of the value of the endoscopic and laparoscopy in the differential diagnosis of GTN, incomplete abortion and ectopic pregnancy. Twenty-seven patients, aged from 24 to 46 years, mean age (36 ± 7) years old, had recurrent vaginal bleeding after 53 ± 37 days of postoperative curettage, serum human chorionic gonadotropin subunit β (3.6-112 469.0 U / L) with a median of 235.5 U / L. Ultrasound examination showed that there were space-occupying lesions in the lumen of the uterus or the uterus in the uterine cavity, See the rich layer of blood flow; pulmonary CT or chest X-ray examination found no abnormalities. 11 cases under the supervision of the official endoscopic surgery; laparoscopy and surgical treatment of 10 cases; hysteroscopy combined with laparoscopy and treatment of 6 cases. Results The final diagnosis was only 4 patients with GTN, and all were choriocarcinoma; 23 patients with non-GTN disease, including 12 cases of uterine horn pregnancy, 1 case of uterine horn remnant pregnancy and 10 cases of incomplete abortion. Twenty-three non-GTN patients were cured by intraoperative or postoperative single intramuscular injection of methotrexate after 6 months of operation. Four patients with GTN were treated with fluorouracil-based chemotherapy , Were completely relieved. Conclusions The main causes of abnormal vaginal bleeding after termination of pregnancy are incomplete abortion, ectopic pregnancy and GTN. When the diagnosis can not be confirmed by comprehensive analysis of clinical history, ultrasonography and serum β-hCG level, routine and effective laparoscopy are the available diagnostic methods.