彩色多谱勒超声在妊娠滋养细胞疾病诊断和治疗中的应用

Clinical usefulness of color Doppler ultrasonography in gestational trophoblastic disease.

目的评价妊娠滋养细胞疾病血流多谱勒特点、血流特点与血β-hCG值相互关系以及病人预后。方法检测41例妊娠滋养细胞疾病病人治疗前后子宫肌层血流多谱勒波形中阻力指数(RI);放射免疫定量测定病人治疗前后血β-hCG值;彩色多谱勒监测病人治疗前后病变部位及大小。结果妊娠滋养细胞疾病病人治疗前血流多谱勒波形中阻力指数较低(0.16-0.45),且血β-hCG含量较高(300-600ng/ml);治疗后阻力指数升高(0.52-0.85),且血β-hCG含量降低(50-100ng/ml),治疗前后阻力指数的升高与血β-hCG含量的降低存在明显相关性。葡萄胎,侵蚀性葡萄胎及绒癌间血流多谱勒波形中阻力指数及血β-hCG含量无显著性差异。可根据彩色多谱勒监测到病变部位、大小及阻力指数(RI)而诊断妊娠滋养细胞疾病并观察治疗效果。结论彩色多谱勒超声较血β-hCG值在诊断妊娠滋养细胞疾病方面具有更大的价值;彩色多谱勒超声也可以监测妊娠滋养细胞疾病的治疗和跟踪妊娠滋养细胞疾病的预后。

Objective ： In this prospective study, we aimed to assess the characteristic of Color Doppler flow of myometrium in patients with gestational trophoblastie disease （GTD）. The relationship between resistance index （RI） and the value of beta HCG, and the patients＇ outcomes after therapy. Methods： Forty - one patients, who were enrolled in the study with hydatidiform mole or invasive mole or choriocareinoma, were assessed with the help of Color Doppler Ultrasound before and after therapy. Quantitative Immunoradiometry surveyed the value of beta HCG. Resistance index （RI） and the value of beta HCG in 41 women treated for gestational trophoblastie disease （GTD） were compared. The place and the size of the myometrial invasions were assessed. Results ： Color Doppler Ultrasound hinted that the resistance index （RI） of blood flow of myometrium in patients with gestational trophoblastie disease （GTD） was low before therapy, while after therapy it apparently droped. Quantitative Immunoradiometry discovered that all the patients had high β - HCG level before therapy, while after therapy the value of beta HCG dramatically fell. There was statistical, significant correlation between dropped β - HCG level and increased value of RI. Twelve patients of 18 were treated with the help of single - agent chemotherapy - -methotrexate （mtx）. On the other hand, six patients were treated with mtx and aetinomycin D combination. Color Doppler Ultrasound disclosed that remission was achieved in all patients. Conclusion： Color Doppler study can more easily detect GTD than the value of β - HCG, meanwhile it can monitor and follow up GTD. In summary it should be stated that Color Doppler Ultrasonography is an useful method in diagnosing and monitoring patients with GTD.