输卵管葡萄胎的治疗和预后——附1例病例报道

Treatment and Prognosis of Tubal Mole: 1 Case Report

目的探讨输卵管葡萄胎治疗方法和预后不良的相关因素。方法报道我院收治输卵管葡萄胎1例,并收集我国从1995年到2010年有关输卵管葡萄胎报告文献17篇,病案24例,并对其治疗方法、病理分型、血β-HCG水平的下降速度和预后的相关性进行分析。结果 24例患者中切除患侧输卵管8例,预后不良1例;切除患侧输卵管的同时行静脉化疗8例,预后不良1例;切除患侧附件1例,预后不良;切除患侧附件的同时行静脉化疗2例,均预后良好;切除患侧附件的同时行盆腔局部化疗1例,预后不良;切除子宫及患侧附件的同时行静脉化疗3例,预后不良1例;行输卵管造口术的同时静脉化疗1例,预后良好。19例有病理分型报告,其中完全性葡萄胎8例,预后不良3例;部分性葡萄胎8例,预后不良1例;侵蚀性葡萄胎3例,预后不良1例。19例有术后血β-HCG,其中13例血β-HCG在手术后1个月内转阴,均愈合良好;有6例转阴时间>1个月,其中预后不良3例。结论异位葡萄胎的治疗以患侧输卵管切除术为主,预防性化疗应具有相应指针;病理分型、血β-HCG水平的下降速度、术后失访、化疗方案不规范是预后不良的相关因素。

Objective To explore the treatments and the factors related to poor prognosis of tubal mole.Methods A case of tubal mole in our hospital was reported,and the report documents on tubal mole was collected from 1995 to 2010,then,the treatments,pathological type,serum β-HCG levels decreased speed and prognosis were analyzed.Results 8of 24 cases were treated with removal of ipsilateral tubal,the prognosis is poor in 1 case;To be treated with removal of ipsilateral tubal intravenous chemotherapy,while 8 cases of poor prognosis in 1 case;To be treated with removal of ipsilateral attachment 1 case with a poor prognosis;To be treated with removal of ipsilateral attachment and intravenous chemotherapy,2 cases were a good prognosis;Being removed pelvic ipsilateral attachment and local chemotherapy in 1 case,a poor prognosis;Being treated with removal of the uterus and ipsilateral attachment with intravenous chemotherapy in 3 cases,poor prognosis in 1 case;Being treated with tubal colostomy at the same time intravenous chemotherapy in 1 case,the prognosis is good.19 cases with pathological type report,which complete mole in 8 cases,prognosis is poor in 3 cases;partial mole in 8 cases,prognosis is poor in 1 case;invasive mole 3 cases,the prognosis is poor in 1 case.19 cases had postoperative serum β-HCG,of which 13 cases of blood β-HCG in the negative within 1 month after surgery,healed well;6 cases of serum β-HCG was negative 1 month after surgery,in which prognosis is poor in 3 cases.Conclusion The main treatment of tube molar was lateral resection.Prophylactic chemotherapy of allopian tube molar should be with the corresponding pointer The factors of age,pathological type,rate of decline of serum β-HCG levels,after lost,non-standard chemotherapy regimen is associated with poor prognosis.