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目的探讨滋养细胞肿瘤误诊为异位妊娠患者的临床表现、病理特征、诊断和治疗。方法1999年6月—2003年12月间,浙江大学医学院附属妇产科医院共收治滋养细胞肿瘤误诊为异位妊娠患者13例,均经病理复核证实,本研究对其临床病理资料进行回顾性分析。结果本病的主要临床表现为停经、下腹痛、异常阴道出血。13例患者中,行血人绒毛膜促性腺激素(hCG)测定者10例,8例患者血hCG>10000IU/L,其中3例患者血hCG>50000IU/L。滋养细胞肿瘤误诊为异位妊娠患者的病灶部位位于输卵管、宫角、阔韧带、卵巢、大网膜及子宫直肠陷凹腹膜等;临床分期[按国际妇产科联盟(FIGO)2000年的标准]Ⅰ期3例,Ⅱ期2例,Ⅲ期3例,Ⅳ期5例;病理诊断绒毛膜癌10例,侵蚀性葡萄胎3例;治疗13例患者均行手术治疗,术后联合化疗。预后随诊2~54个月,均无瘤存活。结论异常增高的血hCG水平及特殊的病灶部位是本病的主要临床表现,有助于异位妊娠和妊娠滋养细胞肿瘤的诊断和鉴别诊断。误诊延误了诊断和治疗,进而可导致肿瘤的转移。
Objective To investigate the clinical manifestations, pathological features, diagnosis and treatment of trophoblastic tumor misdiagnosed as ectopic pregnancy. Methods Between June 1999 and December 2003, 13 cases of trophoblastic tumor misdiagnosed as ectopic pregnancy were treated in Affiliated Obstetrics and Gynecology Hospital of Zhejiang University School of Medicine. All cases were confirmed by pathological examination. The clinicopathological data were reviewed Sexual analysis. Results The main clinical manifestations of this disease are menopause, lower abdominal pain, abnormal vaginal bleeding. Of the 13 patients, 10 were determined for human chorionic gonadotropin (hCG), and 8 patients had hCG> 10,000 IU / L, of which 3 patients had hCG> 50000 IU / L. Trophoblastic tumors misdiagnosed as ectopic pregnancy lesions located in the fallopian tube, cornual angle, broad ligament, ovarian, omental and uterine rectal pouch peritoneum; clinical stage [according to the International Association of Gynecology and Obstetrics (FIGO) 2000 standards ] Stage Ⅰ in 3 cases, stage Ⅱ in 2 cases, stage Ⅲ in 3 cases, stage Ⅳ in 5 cases; pathological diagnosis of choriocarcinoma in 10 cases, invasive hydatidiform mole in 3 cases; treatment of 13 patients underwent surgery and postoperative combined chemotherapy. Prognosis followed up for 2 to 54 months, no tumor survived. Conclusions Abnormally elevated blood levels of hCG and a specific lesion site are the main clinical manifestations of the disease, contributing to the diagnosis and differential diagnosis of ectopic pregnancy and gestational trophoblastic tumors. Misdiagnosis delays diagnosis and treatment, which in turn can lead to tumor metastasis.