宫腔镜和腹腔镜在妊娠滋养细胞肿瘤诊治中的应用

Application of Hysteroscopy and Laparoscopy in Diagnosis and Management of Gestational Trophoblastic Neoplasia

妊娠滋养细胞肿瘤(GTN)好发于育龄期女性,对化疗高度敏感,治愈率可达90%~100%,早期诊断、规范化疗可以改善患者的预后,因此治疗前明确诊断尤为重要。GTN的正确诊断主要依靠病史、体格检查、血人绒毛膜促性腺激素(hCG)水平以及影像学检查,但在临床中,部分非葡萄胎妊娠后的GTN常常难以与其他妊娠相关疾病(如异位妊娠、妊娠物残留等)相鉴别。宫腔镜和腹腔镜是重要的鉴别手段,可以直观了解病灶的位置、大小、性状,也可以直视下取得病理证据进行组织活检,明确诊断,减少误诊误治。对于复发耐药局限于子宫的病灶,可在腹腔镜或宫腔镜的帮助下切除,减少化疗负荷,提高患者的生活质量。因此,内镜技术为GTN的诊疗提供了一种新的选择。

Gestational trophoblastic neoplasia（GTN） usually occurs in women of reproductive age. GTN is sensitive to chemotherapy with a high cure rate of 90%-100%. The early diagnosis and standardized chemotherapy is important for the prognosis. The diagnosis of GTN mainly rely on clinical history, pelvic examination, measure of serum hCG level and imaging examination. However, it is essential to make differential diagnosis with other pregnancy-associated diseases, such as residual of placenta and ectopic pregnancy. To avoid the misdiagnosis and over-treatment, hysteroscopy and laparoscopy play an important role in the differential diagnosis of GTN. They can visually figure out the location, size and character of lesions, or take pathological evidence for under direct vision. They also can effectively salvage some patients with chemoresistant GTN, by resecting the GTN lesion located in the uterus and reducing the total courses of chemotherapy. Endoscopic technique is an effective alternative of diagnosis and treatment for GTN.