A clinical analysis of gestational trophoblastic disease:report of 155 cases
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摘要: 目的 探讨妊娠滋养细胞疾病的临床特征、治疗、预后及随访情况。 方法 收集2008年1月-2013年10月因妊娠滋养细胞疾病入住安徽医科大学第一附属医院155例患者的临床资料,其中葡萄胎99例,滋养细胞肿瘤56例。按年龄分组:<25岁35人,25~35岁49人,>35岁71人。妊娠次数为1次、2次、3次、≥ 4次分别有20、48、55、32人。 结果 患者年龄17~52岁,平均31.7岁;其中年龄>35岁占45.8%,明显高于年龄<25岁组及25~35岁组。。155例患者中妊娠次数为2,3, ≥ 4次分别占31.0%,35.5%,20.6%,与初次妊娠即发病者所占12.9%相比明显增高(P<0.05)。99例葡萄胎患者中行清宫术51例,二次清宫术32例,预防性化疗+清宫术8例,预防性化疗+子宫切除术8例。56例滋养细胞肿瘤患者行MTX单药化疗9例,5-FU单药化疗12例,EMA-Co方案9例,BEP方案8例,VP+DDP方案2例,5-FU+KSM方案16例。化疗疗程3~11个,平均5.47个。葡萄胎的恶变率达12.1%。妊娠滋养细胞肿瘤的治愈率达85.7%。 结论 年龄及既往孕次和妊娠滋养细胞疾病的发生有关:年龄>35岁,妊娠滋养细胞疾病的风险增高;既往有妊娠史者较初孕者发生妊娠滋养细胞疾病的风险高。葡萄胎有恶变倾向,因此,早期诊断、治疗和严密随访至关重要。Abstract: Objective To investigate the clinical features,treatment and outcome of the gestational trophoblastic disease (GTD). Methods The clinical date of 155 in-patients with GTD in our hospital between January,2008 and October,2013 were retrospectively analyzed and summarized.There were 99 cases of hydatidiform mole and 56 cases of trophoblastic tumor.35 patients were less than 25 year-old,49 patients were between 25 and 35 years of age,71 patients aged above 35.The cases with first,second,third or more pregnancies were 20,48,55 and 32,respectively. Results The age of patients were 17 to 52 year-old with an average of 31.7,among them,the patients aged above 35 year-old accounted for 45.8%,which was obviously higher than the proportion of the patients aged less than 25 year-old and between 25 and 35 years old.The incidence of GTD in patients with 2,3 and 4 and more pregnancies was significantly higher than that in patients with the first pregnancy (P<0.05).Among 99 cases of hydatidiform mole,51 patients underwent the dilatation and evacuation,32 cases underwent second curettage,8 patients underwent preventive chemotherapy combined with evacuation,and 8 patients underwent preventive chemotherapy combined hysterectomy.Among 56 cases of gestational trophoblastic neoplasia (GTN),9 patients received single-agent of Methotrexate,12 patients received 5-FU,9 cases received multiple-agent of EMA-Co,8 patients received BEP,2 patients received VP+DDP,and 16 patients received 5-FU+KSM.Chemotherapy courses were 3 to 11,averaged 5.47.The incidence of malignant transformation among hydatidiform mole was 12.1%.The cure rate of GTN was 85.7%. Conclusion The age and times of previous pregnancies are related to the occurrence of GTD.Women aged above 35 will be with a higher risk of GTD.The risk for GTD in women with a reproductive experience is higher than that in first-time moms.The hydatidiform moles tend to undergo malignant transformation.The early diagnosis,treatment and closely follow-up should be paid more attentions to the patients with GTD.
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