足月产后绒癌误诊分析

The reasons of misdiagnosis of postpartum choriocarcinoma

目的 分析足月产后绒癌常见的误诊原因及其预后。方法对1985年-1996年底本院收治272例绒癌中57例足月产后绒癌的诊断治疗进行分析。结果 ①初诊即确诊为足月产后绒癌者5例,占8.8％,而52例误诊,误诊率达91.2％;误诊的52例病人中15例死亡,死亡率28.8％。②临床期别:88％病人就诊时已为晚期高危患者,多伴有肺、脑、肝、肠、膀胱等远处转移。③确诊时间及转归:59.6％病人是在产后3-6个月确诊的。结论 重视足月产后绒癌,对于产后阴道不规则出血病人或年轻经产妇出现其它系统疾患如急性呼吸系统或神经系统症状患者,应常规行血(或尿)绒毛膜促性腺激素(hCG)及β-bCG测定及胸片检查,诊断方法简单、准确且经济。早期产后绒癌可明显降低误诊率,改善患者的预后。

Objective To analyse the causes of misdiagnosis of postpartum choriocarcinoma and their prognosis . Methods : Retrospective analysis of 5 7 cases postpartum choriocarcinoma between 1985 and 1996 in our hospital was done . Results ①5 cases (8.8%) were diagnosed as postpartum choriocarcinoma at their first visits. 52 cases (91.2%) were misdiag-nosed, and 15 cases (28.8%) of them died. ②88% patients had affected multiple metastasis including lung, liver, brain intestine and bladder. ③59.6% patients were diagnosed between 3 and 6 months after postpartum. Only 24.6% patients were diagnosed in three months after their live birth. Conclusions Postpartum choriocarcinoma results in high mortality and multi - agent chemotherapy should be considered. We recommend that a pregnancy test should be examined routinely if a woman continued to bleed during the postpartum period, who failed to respond to first line management after a live birth, or a young parous woman who had rapid onset of neurological or respiratory symptoms compatible with metastatic choriocarcinoma. This is a cheap, reliable and widely available test which may give earlier diagnosis of postpartum choriocarcinoma and lead to an improved outcome for these