不典型宫角妊娠误诊为滋养细胞疾病三例分析

Analysis of Atypical Angular Pregnancy Misdiagnosis of Gestational Trophoblastic Disease(3 Cases)

目的探讨宫角妊娠误诊为滋养细胞疾病(GTD)的原因及鉴别要点。方法回顾性分析3例不典型宫角妊娠患者的诊疗经过,探讨误诊为GTD的原因。结果 3例分别因阴道不规则出血5个月、刮宫术后2个月B超提示宫腔内异常占位病变、停经51 d阴道出血16 d入院,误诊为绒毛膜癌1例、葡萄胎2例。1例有恶性葡萄胎病史者行化疗3 d,2例行手术、1例行两次刮宫未见水泡样胎块且血绒毛膜促性腺激素逐渐下降确诊为宫角妊娠。均愈。结论重视妊娠相关疾病的鉴别诊断,必要时手术探查协助确诊,未确诊时不宜贸然采用放化疗。

Objective To investigate the cause and the main differential manifestations of angular pregnancy misdiagnosed as gestational trophoblastic disease （GTD）. Methods The diagnostic processes of 3 patients with atypical angular pregnancy in our hospital were retrospectively analyzed, and the cause of angular pregnancy misdiagnosed as GTD was discussed. Results The 3 patients were admitted for abnormal bleeding for 5 months, abnormal mass in ultrasound image after 2 months of dilatation and curetrage, and abnormal vaginal bleeding for 16 d after 51 d of menopause respectively. One patient was misdiagnosed as having chorio- carcinoma, and the other two were misdiagnosed as having hydatidiform mole. Two patients were confirmed by operation, and the other one was diagnosed by decreasing haemic chorionic gonadotrophin after two times of dilatation and curettage without mole of pregnancy. All the 3 patients were cured. Conclusion Clinicians must pay more attention to the pregnancy-related diseases, and surgical approach is helpful in some cases. Radiotherapy and chemotherapy should not be taken without confirmed diagnosis.