Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar
Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar
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剖宫产疤痕妊娠滋养细胞肿瘤的识别和治疗
DOI：
10.1002/ijgo.12417
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发表时间：
2018-05-01
影响因子：
3.8
通讯作者：
Xiang, Yang
中科院分区：
文献类型：
--
作者：
Wang, Xiaoyu;Li, Yuan;Xiang, Yang
目的探讨剖宫产术后子宫瘢痕处妊娠滋养细胞瘤（GTN）的临床特点及诊治策略。方法回顾性分析2006年6月1日至2016年5月31日北京协和医院剖宫产术后子宫瘢痕处GTN患者的临床资料。临床特点，诊断和治疗程序，和outcomes reviewed.ResultsOf 938名妇女诊断GTN，31例（3.3%）患者GTN位于剖宫产瘢痕。临床表现以阴道不规则出血为主。20例（65%）患者根据葡萄胎妊娠史/高人绒毛膜促性腺激素水平/典型影像学表现获得准确诊断。其余11例患者最初被误诊，通过病理检查作出明确诊断。所有患者均接受化疗; 22例（71%）女性因化疗耐药病变还接受了子宫切除术或局部子宫病变切除术。所有患者均获得完全缓解;中位随访时间为35个月，仅1例（3%）女性复发。在没有典型表现的患者中，明确的诊断往往依赖于病理学。在治疗上，子宫病变切除术是化疗的一个有用的辅助手段。剖宫产疤痕中妊娠滋养细胞肿瘤的确诊通常需要病理检查;子宫病变切除术是化疗的一个有用的辅助手段。
ObjectiveTo identify the clinical characteristics of, and the diagnostic and therapeutic strategies for, gestational trophoblastic neoplasia (GTN) located in the cesarean scar.MethodsThe present retrospective analysis was conducted among patients diagnosed with GTN located in the cesarean scar at Peking Union Medical College Hospital, Beijing, China, between June 1, 2006, and May 31, 2016. Clinical features, diagnostic and therapeutic procedures, and outcomes were reviewed.ResultsOf 938 women diagnosed with GTN, 31 (3.3%) patients had GTN located in the cesarean scar. Irregular vaginal bleeding was the main clinical manifestation. Twenty (65%) patients received an accurate diagnosis based on a history of molar pregnancy/a high -human chorionic gonadotropin level/typical imaging presentations. The remaining 11 patients were initially misdiagnosed; the definitive diagnosis was made by pathology. All patients received chemotherapy; 22 (71%) women also underwent hysterectomy or localized uterine lesion resection because of chemoresistant lesions. All patients had a complete remission; at a median follow-up of 35months, only 1 (3%) woman had a relapse.ConclusionOwing to its rarity and nonspecific symptoms, GTN located in the cesarean scar is prone to misdiagnosis. In patients without typical manifestations, the definitive diagnosis often relies on pathology. For treatment, uterine lesion resection is a useful adjunct to chemotherapy.Definitive diagnosis of gestational trophoblastic neoplasia in a cesarean scar often required pathological examination; uterine lesion resection was a useful adjunct to chemotherapy.