40岁以上滋养细胞疾病86例临床分析

目的:滋养细胞疾病是妇科常见病,但对于40岁以上滋养细胞疾病的诊治在临床上是经常容易被忽视、被误诊的疾病。该文探讨40岁以上滋养细胞疾病的临床特点、诊断、治疗及预后。方法:采用回顾性方法分析1982年7月~2002年12月共收治滋养细胞疾病392例,其中40岁以上患者86例。侵蚀性葡萄胎46例(Ⅰ期29例、Ⅱ期5例、Ⅲ期12例)。绒癌17例(Ⅰ期9例、Ⅱ期3例、Ⅲ期3例、Ⅳ期2例)。结果:86例滋养细胞疾病病人中,误诊23例,误诊率为26.7%。75例行子宫全切术手术治疗。其中全子宫加双附件切除者48例,全子宫加单附件切除者12例,单纯子宫切除者15例(附件切除均行卵巢动静脉高结扎)。术后病理证实为恶性者66例,恶变率为76.7%。术后患者全部进行化疗。结论:40岁以上滋养细胞疾病临床诊断误诊率高,恶变率高,应引起临床高度重视。

The clinical analysis of 86 patients over 40 years old with gestational trophoblastic disease

Gestational trophoblastic disease (GTD) is a kind of common disease. They are usually misdiagnosed and the proper treatment were delayed for women over 40 years. This paper analyzed the clinical characteristics, diagnosis, treatment, and prognosis of GTD. Methods: The clinical data of 86 cases of GTD patients admitted between July 1982 and December 2002 in Beijing Obstetrics Gynecologic Hospital, were analyzed retrospectively. There were 46 cases of invasive mole, 17 cases of choriocarcinoma. Results: Among 86 patients, 23 were misdiagnosed preoperatively. The misdiagnosis rate was 26.7%, Hysterectomy were performed in 75 patients. 66 cases were malignant by postoperative pathologic diagnosis. The malignant change rate were 76. 7%. Postoperative chemotherapy were given in all cases. Conclusion: As for GTD patients over 40 years, its misdiagnosis rate and malignant change rate were high, which should be paid great attention to.