高危因素对葡萄胎后恶变的影响临床分析

目的：分析有恶变高危因素的葡萄胎患者的临床特点，为提高妊娠滋养细胞肿瘤（GTN）的诊治手段提供借鉴。方法回顾性分析该院妇产科2007年1月至2013年12月162例在行清宫术后病理检查诊断为葡萄胎患者的临床资料，观察GTN的临床表现、治疗效果等，比较有高危因素与无高危因素葡萄胎后GTN患者的临床特点。结果162例葡萄胎患者中，有46例恶变，其中有高危因素患者36例，无高危因素患者10例。比较两类患者恶变率、临床表现及治疗后效果，早期葡萄胎合并高危因素患者恶变率及临床表现与无合并高危因素患者比较，差异均有统计学意义（P＜0.05）；葡萄胎后GTN患者治疗效果比较，差异无统计学意义（P＞0.05）。结论葡萄胎恶变率与患者发病年龄、子宫大小、卵巢黄素囊肿等高危因素有关。因此，对患者高危因素进行正确评估，对临床早期预测葡萄胎恶变及给予预防性化疗有一定指导意义，也有助于诊治GTN和提高临床疗效。

Clinical analysis of high-risk factors on malignant transformation of hydatidiform mole

Objective To analyze the clinical features of hydatidiform mole patients with high-risk factors,in order to provide reference for improving the diagnosis of the gestational trophoblastic tumor （GTN）. Methods A retrospective analysis was conducted on clinical data of 162 hydatidiform mole patients ,who were diagnosed after uterine curettage by pathological ex-amination in the Obstetrics Department of the hospital from January 2007 to December 2013. To observe the clinical manifesta-tions of GTN,therapeutic effect and so on,and compare the clinical features of hydatidiform mole patients with and without high-risk factors. Results Amon the 162 patients with hydatidiform mole,46 cases had malignant transformation,including 36 cases with high-risk factors and 10 cases without high-risk factors. The malignant transformation rate,clinical manifestation and thera-peutic effects between the two kinds of patients were compared ,and the comparison on malignant transformation rate and clinical manifestation between the patients with high-risk factors and patients without high-risk factors had statistically significant differ-ence （P〈0.05）;the therapeutic effects of GTN patients after mole treatment between the two kinds patiens had no statistically sig nificant difference（P〉0.05）. Conclusion The malignant transformation rate of hydatidiform mole patients is related with age of onset,uterine size,ovarian lutein cysts and other factors,so proper evaluation to the high-risk factors has certain guidance for early prevention of hydatidiform mole in clinical and preventive chemotherapy ,and it also benefits to diagnose of GTN and improve clinical efficacy.