宫内妊娠合并葡萄胎3例临床分析

Clinical analysis on hydatidiform mole with co-existent fetus

目的:探讨宫内妊娠合并葡萄胎的临床特点、早期诊断及处理方法。方法:回顾分析2015年7月至2017年11月在华中科技大学同济医学院附属同济医院经临床及病理证实为宫内妊娠合并葡萄胎的3例孕妇的临床资料,包括临床特点、诊断与鉴别诊断及处理方法。结果:3例患者的年龄26~32岁,平均28.3岁;诊断孕周11^(+5)~17^(+2)周,平均孕15周;自然妊娠2例(66.7%)、体外受精-胚胎移植1例(33.3%);终止妊娠孕周12^(+4)~21^(+4)周,平均孕17^(+2)周。主要临床表现为反复阴道少量流血(100.0%)、咳嗽(66.7%)、恶心呕吐(66.7%)、卵巢黄素化囊肿(66.7%)、腹胀(33.3%)、甲状腺功能亢进症(33.3%)等。3例患者的血β-HCG均大于2×10~5m IU/ml,均通过B超早期诊断。结论:宫内妊娠合并葡萄胎患者在妊娠早期易出现反复阴道流血、咳嗽、恶心呕吐等不典型临床表现,可通过异常增高的血β-HCG及B超早期发现并诊断。

Objective:To discuss the clinical features,early diagnosis and treatment of hydatidiform mole with co-existent fetus.M ethod:3 cases of hydatidiform mole with co-existent fetus confirmed by clinical and pathology were collected at the Department of Obstetrics and Gynecology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from Jul.2015 to Nov.2017.The clinical features,diagnosis,differential diagnosis and treatment were retrospectively analyzed.R e su lt:Patients were aged from 26 to 32 years,with an average age of 28.3 years.The first time they were diagnosised as hydatidiform mole with co-existent fetus was at 11^+5w to 17^+2w,with an average of 15 gestational weeks.2 cases(66.7%)were naturally conceived,and another(33.3%)got pregnancy after IV F-ET.They terminated the pregnancy during 12^+4w to 21^+4w,with the average gestational weeks being 17^+2w.Clinical manifestations were mainly repeatedly vaginal bleeding(100.0%),coughing(6 6.7%),nausea and vomiting(66.7%),ovarian luteinized cyst(6 6.7%),abdominal bloating(33.3%)and hyperthyroidism(33.3%).The serumβ-HCG concentrations of the 3 patients were all higher than 2×105 mIU/m l,and they were all early diagnosed by B ultrasound.Conclusions:Hydatidiform mole with co-existent fetus is prone to atypical clinical symptoms such as repeatedly vaginal bleeding,coughing,nauseating and vomiting in early pregnancy,thus can be discovered and diagnosed in early period through abnormally increased serumβ-HCG and Bultrasound.