米非司酮药物流产后发生恶性滋养细胞肿瘤2例临床分析

Clinical Analysis of Two Cases with Malignant Trophoblastic Tumor after Mifepristone Abortion

目的探讨应用米非司酮行药物流产后发生恶性滋养细胞肿瘤的临床特点及其与不全药物流产的鉴别诊断.方法对2例应用米非司酮行药物流产后发生恶性滋养细胞肿瘤的患者进行临床分析.结果药物流产后发生恶性滋养细胞肿瘤患者与不全药物流产一样,表现为不规则阴道出血,β-hCG高于正常,但前者动态监测或刮宫术后β-hCG呈明显上升趋势;彩色多普勒血流图显示子宫动脉扩张,子宫旁血管有滋养细胞浸润,可见肿瘤染色、动静脉漏等.结论米非司酮药物流产后,阴道异常出血者有早期恶性滋养细胞肿瘤发生的可能,动态监测β-hCG、彩色多普勒血流图及血管减影术是诊断药物流产后发生恶性滋养细胞肿瘤及其与不全流产鉴别诊断的有效方法.

Objective To describe the clinical characteristics of malignant gestational trophoblastic tumor after medical abortion used by mifepristone combined with misoprostol and its diagnosis and differential diagnosis from incomplete abortion. Method Two cases with malignant gestational trophoblast tumor after medical abortion were focused on the clinical manifestation. Results Irregular vaginal bleeding and abnormal high level of B-human chorionic gonadotropin（hCG） in plasma were the common manifestation of the gestational trophoblast tumor and incomplete abortion after medical abortion. However, B-hCG of the former after curettage was still higher by dynamic monitoring. Malignant gestational trophoblast tumor showed rich blood flow signal and low blood flow resistance index in uterus in color doppler echography, digital subtraction angiography （DSA） with abnormal enlargement of the arteria of uterine, arteriovenous fistula beside the uterine were the main characteristics of malignant gestational trophoblast tumor. Conclusion Pay attention to the early stage malignant gestational trophoblast tumor among patients with abnormal vaginal bleeding after medical abortion. B-hCG and DSA were the most effective methods to diagnose and differentially diagnose choriocarcinoma from the incomplete abortion among the patients with abnormal vaginal bleeding after medical abortion.