盆腔外滋养细胞肿瘤的诊治分析

Analysis on diagnosis and treatment of extrapelvic trophoblastic carcinoma

目的:分析39例Ⅳ期滋养细胞肿瘤的诊治经过,探讨如何降低误诊率改善预后。方法:对39例Ⅳ期滋养细胞肿瘤患者的诊断、治疗过程及结果进行回顾性分析。结果:总首诊确诊率64.1%(25/39),误诊率35.9%(14/39)。首诊于武汉大学人民医院妇产科和其他科室及外院的误诊率分别为0(0/16)、76.47%(13/17)、16.67%(1/6);首诊时合并生殖系统症状的误诊率11.11%,无合并者误诊率91.67%;首诊距末次妊娠时间>1年者误诊率53.33%(8/15),6月～1年者误诊率8.18%(2/11),<6月者误诊率0。39例患者总完全缓解率为76.92%(30/39),首诊确诊者完全缓解率88%(22/25),首诊误诊者完全缓解率57.14%(8/14);确诊时血β-HCG值≤105 mIU/ml者的完全缓解率为100%,>105 mlU/ml者的完全缓解率为65.38%(17/26);以上所有差异均有统计学意义(P<0.05)。结论:Ⅳ期滋养细胞肿瘤的首诊误诊率高与其症状无特异性和临床医师认识不足有关且影响预后,应提高临床医师的认识降低误诊率。

Objective：To analyze the diagnosis and treatment of trophoblastic carcinoma in IV stage,explore the measures to decrease misdiagnosis rate and improve the prognosis.Methods：The diagnosis,treatment and outcomes of 39 cases with trophoblastic carcinoma in IV stage were analyzed retrospectively.Results：The total definite diagnosis rate on first attendance was 64.1%（25/39）,while the misdiagnosis rate was 35.9%（14/39）.The misdiagnosis rate on first attendance in gynecological department and other departments in People＇s Hospital and in other hospitals were 0（0/16）,76.47%（13/17） and 16.67%（1/6）,respectively;the misdiagnosis rates of first diagnosed symptoms with or without reproductive discomfort were 11.11% and 91.67%,respectively;the misdiagnosis rates of time interval between the last pregnancy and first attendanceone year,6 months～one year,6 months were 53.33%（8/15）,8.18%（2/11） and 0,respectively;the total complete remission rate of 39 patients was 76.92%（30/39）,the complete remission rates of first definite diagnosis and first misdiagnosis were 88%（22/25） and 57.14%（8/14）;the complete remission rates of patients with β-HCG≤105 mIU/ml and β-HCG105 mlU/ml were 100% and 65.38%（17/26）,respectively;all the differences above had significance（P0.05）.Conclusion：High misdiagnosis rate on first attendance in patients with trophoblastic carcinoma in IV stage is related to insufficient understanding of clinical doctors,which affects prognosis,clinicians should increase awareness about this disease in order to decrease misdiagnosis rate.