滋养细胞疾病15例误诊分析

Differential diagnosis of gestational trophoblast disease.

目的:探讨滋养细胞疾病的正确诊断及鉴别诊断。方法:回顾分析2000年1月至2004年7月收治的将滋养细胞疾病误诊为其它疾病8例及将其它疾病误诊为滋养细胞疾病7例的临床资料。结果:滋养细胞疾病8例误诊为异位妊娠5例,不全流产2例,子宫肌瘤1例;误诊为滋养细胞疾病的7例中异位妊娠4例,早孕合并阔韧带肌瘤、动静脉瘘及不全流产各1例。结论:滋养细胞疾病的正确诊断应该结合病史,HCG监测,影像学检查,刮宫等综合考虑,对难以诊断的患者不能盲目化疗,可以通过腹腔镜或开腹手术以明确诊断。

Objective: To explore the diagnosis and the differential diagnosis of gestational trophoblast disease(GTD).Methods:The clinical data of 15 cases with misdiagnosed GTD from Jan 2000 to July 2004 in PUMC Hospital were analyzed,including 8 cases of GTD misdiagnosed of other diseases and 7 cases as other diseases over-diagnosed as GTD.Results:Of the 8 cases of GTD misdiagnosed as other diseases,5 cases were ectopic pregnancies,2 cases were incomplete abortions,1 case was myoma of uterus.Of the 7 cases of other diseases overdiagnosed as GTD,4 cases were ectopic pregnancies,the other three were early pregnancy accompanied with myoma,arterio venous fistula and incomplete abortion individually.Conclusion: The diagnosis and the differential diagnosis of GTD should be made in accordance with considering all diagnostic procedures,such as clinical history and examination,measure of serum HCG level,colour ultrosound,digital subtraction angiography(DSA),and diagnostic curettage,so as to avoid the misdiagnosis and over-diagnosis.In case of elusive patients,chemotherapy should not be given blindly and the recommended reliable managment is laparoscopy or laparotomy.