早产剖宫产后发现绒毛膜癌一例

A Case of Choriocarcinoma Discovered after Preterm Cesarean Section

绒毛膜癌是恶性程度极高的一类滋养细胞肿瘤,早产剖宫产后绒毛膜癌的病例较为少见,报告1例早产剖宫产后发现的绒毛膜癌病例情况。患者因胎心监护反应欠佳、胎儿超声脐动脉收缩期最大血流速度与舒张末期血流速度的比值(S/D)异常和甲胎蛋白异常升高行子宫下段剖宫产,新生儿出生后诊断贫血。患者剖宫产后持续异常阴道出血1个月余,复查人绒毛膜促性腺激素β亚单位(β-human chorionic gonadotropin,β-hCG)呈高水平,超声提示宫内异常回声团,除外妊娠物残留及再次妊娠,结合病史、临床表现、专科检查及辅助检查考虑诊断为绒毛膜癌,行氟尿嘧啶+更生霉素第1~8天静脉化疗治疗3个疗程后复查β-hCG为4.13 IU/L。随访至2024年5月母儿结局良好。因此,不论患者是否为足月妊娠,对于产后异常阴道出血、β-hCG水平异常的产妇需要警惕妊娠滋养细胞肿瘤,及时早期诊断、治疗,化疗后定期随访。

Choriocarcinoma is a highly malignant type of trophoblastic tumor,and cases of choriocarcinoma detected after preterm cesarean section are rare.This report details a case of choriocarcinoma discovered following a preterm cesarean section.The patient underwent a lower segment cesarean section due to poor fetal heart monitoring,an abnormal S/D ratio in the umbilical artery on fetal ultrasound,and elevated alpha-fetoprotein levels.After birth,the newborn was diagnosed with anemia.The patient experienced persistent abnormal vaginal bleeding for more than a month post-cesarean section.A follow-up test revealed elevated levels ofβ-human chorionic gonadotropin(β-hCG),and ultrasound showed an abnormal intrauterine echo mass.After excluding retained products of conception and new pregnancy,and considering the patient′s history,clinical presentation,specialized examinations,and auxiliary tests,the diagnosis of choriocarcinoma was made.The patient was treated with three courses of fluorouracil and methotrexate chemotherapy from day 1 to day 8,and the follow-upβ-hCG level decreased to 4.13 IU/L.Both mother and child had a favourable outcome as of the follow-up in May 2024.Therefore,regardless of whether the patient has a full-term pregnancy,abnormal postpartum vaginal bleeding and abnormalβ-hCG levels in postpartum women should raise suspicion for gestational trophoblastic tumors.Early diagnosis and treatment,along with regular follow-up after chemotherapy,are crucial.