妊娠滋养细胞疾病误诊为异位妊娠三例临床分析及文献复习

Clinical Analysis of 3 Cases of Gestational Trophoblastic Disease Misdiagnosed as Ectopic Pregnancy and Literature Review

目的探讨误诊为异位妊娠的妊娠滋养细胞疾病(gestational trophoblastic disease,GTD)患者的临床特点、诊治方法、误诊原因及防范措施。方法回顾性分析曾诊断异位妊娠、经术后病理检查确诊的GTD 3例临床资料。结果本组2例因急腹症就诊,经常规查体、超声及血人绒毛膜促性腺激素(HCG)和尿妊娠试验初诊为异位妊娠,经手术后病理检查确诊为输卵管绒毛膜癌和输卵管侵蚀性葡萄胎各1例;1例因下腹痛、自测尿妊娠试验阳性、突然晕倒诊断为异位妊娠,行左侧输卵管切除术后出现恶心呕吐、盆腔积血、血压升高,取手术标本病理会诊修正诊断为输卵管侵蚀性葡萄胎。3例确诊后经标准联合化疗治愈。结论特殊部位的GTD早期临床表现不典型,类似异位妊娠时易误诊,通过手术获取病理组织送检,重视监测血HCG变化,可避免延误诊治。

Objective To evaluate clinical features,diagnosis and treatment measures,causes of misdiagnosis and preventive measures of gestational trophoblastic disease(GTD)misdiagnosed as ectopic pregnancy.Methods The clinical data of 3 patients with pathologically confirmed GTD misdiagnosed as ectopic pregnancy were retrospectively analyzed.Results In this group,2 patients presented with acute abdomen.After physical examination,ultrasound and blood human chorionic gonadotropin(HCG)and urine pregnancy test,they were diagnosed with ectopic pregnancy.After postoperative pathological examination,one case was diagnosed as tubal choriocarcinoma,and the other as invasive hydatidiform mole in fallopian tube.One patient was diagnosed as ectopic pregnancy due to lower abdominal pain,self-tested positive result for urine pregnancy test,and sudden fainting.After left fallopian tube resection,the patient experienced nausea and vomiting,pelvic hemorrhage,and increased blood pressure.The pathological examination of the surgical specimen and consultation confirmed invasive hydatidiform mole in fallopian tube.Three patients were cured by standard combination chemotherapy.Conclusion Given atypical early clinical manifestations in specific areas,GTD is likely to be misdiagnosed when similar to ectopic pregnancy.Pathological tissues obtained during operation for examination and monitoring changes in blood HCG can help avoid delay in diagnosis and treatment.