本文選題：雙胎　切入點：部分性葡萄胎　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景：妊娠合并葡萄胎在臨床上較為少見。它可分為完全性葡萄胎和部分性葡萄胎合并一個胎兒兩種類型,其中以完全性葡萄胎合并一個胎兒為主,胎兒存活幾率高,發(fā)展為持續(xù)滋養(yǎng)細胞疾病的幾率高；部分性葡萄胎胎兒通常在妊娠早期死亡,罕有活胎能生存到妊娠中、晚期,發(fā)展為持續(xù)滋養(yǎng)細胞疾病的幾率稍低。 目的：探討葡萄胎與胎兒共存的可能的發(fā)病原因、組織病理特點、臨床表現(xiàn)、妊娠結(jié)局及產(chǎn)前診斷-主要是依靠超聲、病理和染色體核型分析在診斷部分性葡萄胎中的作用,有利于指導(dǎo)產(chǎn)科醫(yī)師在臨床中對此類患者進行全面的孕期及產(chǎn)后評估,保證孕婦及新生兒的健康。 方法：總結(jié)2012年我院收治的一例雙胎妊娠,部分性葡萄胎與胎兒共存剖宮產(chǎn)術(shù)后繼發(fā)絨癌患者的治療經(jīng)過及隨訪結(jié)果,將其臨床資料作以詳細報導(dǎo)。 結(jié)果：患者因“胎膜早破、胎兒窘迫”剖宮產(chǎn)娩兩名正常的早產(chǎn)女嬰。術(shù)中見：子宮后壁見大小不等的水泡樣組織與長女胎盤相續(xù),術(shù)后胎盤病理診斷為部分性葡萄胎。術(shù)后HCG持續(xù)上升且影像學(xué)檢查示肺轉(zhuǎn)移,診斷為侵蝕性葡萄胎,由產(chǎn)科轉(zhuǎn)入婦科進行治療。經(jīng)化療后,血HCG降至正常,效果滿意。隨訪1年后,兩女嬰外觀未見明顯異常,智力評估檢查未見明顯差異。但患者出現(xiàn)停經(jīng)癥狀,查血HCG升高,再次收入院,排除妊娠后,考慮妊娠滋養(yǎng)細胞疾病復(fù)發(fā),最后患者行子宮切除術(shù),術(shù)后病理診斷為絨毛膜癌,術(shù)后予以化療�，F(xiàn)生命體征平穩(wěn),仍在嚴密隨訪。 結(jié)論：妊娠合并部分性葡萄胎且胎兒存活極為少見。對于此類患者,產(chǎn)前明確診斷,尤其是彩超、病理及染色體核型分析,對于決定是否繼續(xù)妊娠和判斷預(yù)后十分重要。妊娠合并葡萄胎患者常常需要產(chǎn)科與婦科醫(yī)師的密切配合進行診治,多數(shù)患者預(yù)后良好。
[Abstract]:Background: pregnancy with hydatidiform mole is rare in clinic. It can be divided into two types: complete mole and partial mole combined with one fetus. The risk of developing persistent trophoblastic disease is high; partial hydatidiform mole usually dies at the early stage of pregnancy, few live fetus can survive to pregnancy, and later stage, the probability of developing persistent trophoblastic disease is lower. Objective: to investigate the possible pathogenesis, histopathological features, clinical manifestations, pregnancy outcome and prenatal diagnosis of hydatidiform mole coexisting with fetus, which mainly rely on ultrasound, pathology and karyotype analysis in the diagnosis of partial hydatidiform mole. It is helpful to instruct obstetricians to make comprehensive evaluation of such patients during pregnancy and postpartum, and to ensure the health of pregnant women and newborns. Methods: in 2012, a case of twin pregnancy, partial hydatidiform mole and fetal coexisting cesarean section secondary choriocarcinoma treatment and follow-up results were summarized, and the clinical data were reported in detail. Results: due to premature rupture of membranes and fetal distress, two normal preterm female infants were delivered by cesarean section. The pathological diagnosis of placenta after operation was partial hydatidiform mole. After operation, HCG continued to rise and imaging examination showed pulmonary metastasis. It was diagnosed as invasive hydatidiform mole and transferred from obstetrics to gynecology for treatment. After chemotherapy, the blood HCG decreased to normal. The results were satisfactory. After one year of follow-up, there was no obvious abnormality in appearance and no significant difference in intelligence assessment between the two female infants. However, the patient appeared menopause symptoms, blood HCG increased, and was admitted to hospital again, excluding pregnancy, taking into account the recurrence of gestational trophoblastic disease. Finally, the patient underwent hysterectomy, postoperative pathological diagnosis of choriocarcinoma, postoperative chemotherapy. Conclusion: pregnancy with partial hydatidiform mole and fetal survival is very rare. For such patients, prenatal diagnosis is definite, especially color Doppler ultrasound, pathology and karyotype analysis. It is very important to decide whether to continue pregnancy and to judge the prognosis. Patients with pregnancy complicated with hydatidiform mole often need close cooperation between obstetrics and gynecologist for diagnosis and treatment. Most patients have a good prognosis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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