滋养细胞疾病9例误诊分析

Analysis of misdiagnosis of gestational trophoblastic 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4月—2010年10月收治的将滋养细胞疾病误诊为其他疾病7例,将其他疾病误诊为滋养细胞疾病2例的临床资料。结果滋养细胞疾病7例误诊为异位妊娠3例,不全流产2例,过期流产2例;误诊为滋养细胞疾病的2例中葡萄胎术后残留1例,人流术后残留1例。结论滋养细胞疾病的正确诊断应该结合临床表现、体征、β-HCG监测、B超、胸片和肺部CT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将组织物送病理以明确诊断。

Objective To analyze the factors related to misdiagnosis of gestational trophoblastic disease （GTD）. Methods The clinical data of 9 cases with misdiagnosed GTD from Apr. 2000 to Oct. 2010 in Tongji Hospital were analyzed, including 7 cases GTD misdiagnosed as other diseases and 2cases of other conditions misdiagnosed as GTD. Results Of the 7 cases of GTD misdiagnosed as other disease, 3 cases were ectopic pregnancies, 2 cases were incomplete abortion, 2 cases were misses abortion. Of the 2 cases of other conditions misdiagnosed as GTD, one was residue after curettage of hydatiform mole, one was residue after artificial abortion. Conclusion The correct diagnosis of GTD should be based on the combination of clinical symptoms and signs with β-HCG monitoring, ultrasonography pelvis, chest X-ray or chest CT and other comprehensive considerations. In elusive patients, chemotherapy should not be given blindly and laparoscopy or laparotomy with pathological examination is necessary for confirmation of diagnosis.