胎盘残留与妊娠滋养细胞疾病的甄别
Journal of Practical Obstetrics and Gynecology（2021）
Abstract
胎盘残留(residual placenta)是产后30分钟胎盘未完全排除而残留于宫腔内的产后并发症,它是引起产后出血、宫腔感染的主要原因[1].妊娠滋养细胞疾病(gestational trophoblastic disease,GTD)是一组来源于胎盘滋养细胞的疾病.根据良恶性进行分类,其中良性滋养细胞疾病包括完全性葡萄胎、部分性葡萄胎、滋养细胞超常反应(exaggerated placental site,EPS)以及胎盘部位结节;而恶性疾病又称妊娠滋养细胞肿瘤(gestational trophoblastic neoplasm,GTN ),包括侵袭性葡萄胎、绒癌、胎盘部位滋养细胞肿瘤(placen-ta-site trophoblastic tumor,PSTT)以及上皮样滋养细胞肿瘤[2].在临床的实际操作中,不典型的胎盘残留与GTN在临床表现、实验室检查以及影像学检查方面均存在着容易混淆之处,例如两者均容易发生在人工流产、药物流产或产后一段时间内、患者常伴有不规则的阴道流血、伴或不伴下腹痛、血和尿人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)阳性、超声检查显示子宫血流丰富、宫腔有占位、与子宫肌层分界不清,而这些相似点常常使得两者之间容易发生误诊[3].而两者在病理学表现及临床处理方面存在巨大差异.因此为了减少误诊,避免给患者带来不必要的伤害,本文就胎盘残留与部分GTD之间的鉴别诊断进行阐述.
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