输卵管妊娠葡萄胎合并腹腔内出血一例

doi:10.12280/gjszjk.20230250

摘要/Abstract

摘要：

输卵管妊娠葡萄胎在临床上极为罕见，术前诊断大多存在困难，确诊主要依靠术后组织病理学诊断。报告1例38岁女性因右侧输卵管妊娠破裂致腹腔内出血急诊行腹腔镜右侧输卵管切除术，术后病理提示完全性葡萄胎的病例。该患者术后恢复良好，随访期间血清人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）下降满意，无阴道出血、咳嗽和咳血等相关病灶转移症状。输卵管妊娠葡萄胎多表现为急腹症，因此对于急腹症患者临床上应警惕葡萄胎的可能性，其治疗多以手术为主，必要时行化疗，术后需严密随访，注意病变侵蚀及恶变可能。

关键词: 妊娠, 输卵管, 妊娠, 异位, 葡萄胎, 腹腔, 出血

Abstract:

Tubal ectopic pregnancy with hydatidiform mole is extremely rare in clinical practice, and preoperative diagnosis is often difficult. The diagnosis is mainly based on the postoperative histopathology results. This article reports a 38-year-old woman whom underwent laparoscopic right fallopian tube resection in an emergency due to rupture of right fallopian tube pregnancy. The postoperative pathology revealed completeness hydatidiform mole. The patient recovered well after surgery, with a satisfactory decrease in serum human chorionic gonadotropin (hCG) during the follow-up period. There were no symptoms of vaginal bleeding, coughing, hemoptysis, or related lesion metastasis. Tubal pregnancy with hydatidiform mole often manifests as acute abdominal disease. Therefore, for patients with acute abdominal disease, the possibility of hydatidiform mole should be paid to. The treatment is mainly based on surgery, and chemotherapy should be performed if necessary. After surgery, close follow-up is required, and doctors should be noting the possibility of lesion erosion and malignancy too.

Key words: Pregnancy, tubal, Pregnancy, ectopic, Hydatidiform mole, Abdominal cavity, Hemorrhage

张佟, 叶红. 输卵管妊娠葡萄胎合并腹腔内出血一例[J]. 国际生殖健康/计划生育杂志, 2024, 43(1): 28-31.

ZHANG Tong, YE Hong. A Case of Tubal Ectopic Pregnancy with Hydatidiform Mole and Intraperitoneal Hemorrhage[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(1): 28-31.

图/表 4

图1 经阴道妇科超声图注：子宫上方非均质回声，范围约7.5 cm×7.6 cm×5.5 cm，形态不规则，盆腹腔可见大量液性暗区。

图2 腹腔镜探查术中所见注：A 盆腹腔内可见大量陈旧性积血；B 子宫右上方见陈旧性凝血块约10 cm×10 cm×8 cm；C 积血块后方见右侧输卵管峡部增粗膨大，表面可见破口。

图3 术后病理图（HE染色×40）

图4 滋养叶细胞和绒毛间质细胞免疫组织化学染色p57阴性（MaxVision法×40）

参考文献 18

[1]	Lukinovic N, Malovrh EP, Takac I, et al. Advances in diagnostics and management of gestational trophoblastic disease[J]. Radiol Oncol, 2022, 56(4):430-439. doi: 10.2478/raon-2022-0038. pmid: 36286620
[2]	Xiao P, Guo T, Yin R. Misdiagnosis of gestational trophoblastic neoplasia as ectopic pregnancy: A 15-year retrospective study[J]. Front Med(Lausanne), 2022, 9:1018573. doi: 10.3389/fmed.2022.1018573.
[3]	Zhao Y, Huang B, Zhou L, et al. Challenges in diagnosing hydatidiform moles: a review of promising molecular biomarkers[J]. Expert Rev Mol Diagn, 2022, 22(8):783-796. doi: 10.1080/14737159.2022.2118050. pmid: 36017690
[4]	中国抗癌协会妇科肿瘤专业委员会. 妊娠滋养细胞疾病诊断与治疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(6):520-532. doi: 10.19401/j.cnki.1007-3639.2021.06.10.
[5]	Chawla T, Bouchard-Fortier G, Turashvili G, et al. Gestational trophoblastic disease: an update[J]. Abdom Radiol(NY), 2023, 48(5):1793-1815. doi: 10.1007/s00261-023-03820-5.
[6]	Hasan A, Elhawary A, Abdelaleem MF, et al. Partial Hydatidiform Mole in an Ectopic Tubal Pregnancy[J]. Cureus, 2021, 13(6):e15455. doi: 10.7759/cureus.15455.
[7]	López CL, Lopes V, Resende FR, et al. Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects[J]. Rev Bras Ginecol Obstet, 2018, 40(5):294-299. doi: 10.1055/s-0038-1653976.
[8]	Ayyash M, Kole M, Le Q, et al. Partial Molar Pregnancy Presenting as a Tubal Ectopic Pregnancy[J]. Case Rep Obstet Gynecol, 2022, 2022:7414190. doi: 10.1155/2022/7414190.
[9]	程广艳, 曲芃芃. 葡萄胎的规范化处理[J]. 中国实用妇科与产科杂志, 2022, 38(7):684-687. doi: 10.19538/j.fk2022070104.
[10]	鞠蕊, 赵桂君, 张健, 等. 异位葡萄胎1例报告[J]. 中国微创外科杂志, 2019, 19(8):760-762. doi: 10.3969/j.issn.1009-6604.2019.08.024.
[11]	杨桦. 异位葡萄胎的临床诊断及治疗进展[J]. 中国优生与遗传杂志, 2008, 16(7):126,83.
[12]	林川, 胡辉权, 罗祥力, 等. 阔韧带部分性葡萄胎1例报告[J]. 中国实用妇科与产科杂志, 2018, 34(7):828-829. doi: 10.19538/j.fk2018070127.
[13]	马水清, 向阳, 杨秀玉, 等. 异位葡萄胎的诊断与治疗——附三例病例报告[J]. 中华妇产科杂志, 2001, 36(10):618-620. doi: 10.3760/j.issn:0529-567X.2001.10.011.
[14]	王威. 经阴道超声诊断异位葡萄胎的特征与价值[J]. 中国卫生标准管理, 2020, 11(15):116-118. doi: 10.3969/j.issn.1674-9316.2020.15.051.
[15]	Swamy SR, Swamy MR, Samanvitha H, et al. MR"I": An "eye" for the preoperative diagnosis of ectopic molar pregnancy, a case report[J]. J Family Med Prim Care, 2023, 12(3):581-585. doi: 10.4103/jfmpc.jfmpc_1770_22. pmid: 37122670
[16]	Zhao T, Hou X, Su C, et al. Tubal hydatidiform mole treated with salpingotomy: A case report[J]. Clin Case Rep, 2019, 7(4):653-655. doi: 10.1002/ccr3.2037.
[17]	D′Asta M, La Ferrera N, Gulino FA, et al. Is It Possible to Diagnose Preoperatively a Tubal Ectopic Hydatidiform Molar Pregnancy? Description of a Case Report and Review of the Literature of the Last Ten Years[J]. J Clin Med, 2022, 11(19):5783. doi: 10.3390/jcm11195783.
[18]	Athanasiou A, Féki A, Fruscalzo A, et al. Ruptured ectopic pregnancy as complete hydatidiform mole: Case report and review of the literature[J]. Front Surg, 2022, 9:1036435. doi: 10.3389/fsurg.2022.1036435.