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目的:分析39例Ⅳ期滋养细胞肿瘤的诊治经过,探讨如何降低误诊率改善预后。方法:对39例Ⅳ期滋养细胞肿瘤患者的诊断、治疗过程及结果进行回顾性分析。结果:总首诊确诊率64.1%(25/39),误诊率35.9%(14/39)。首诊于武汉大学人民医院妇产科和其他科室及外院的误诊率分别为0(0/16)、76.47%(13/17)、16.67%(1/6);首诊时合并生殖系统症状的误诊率11.11%,无合并者误诊率91.67%;首诊距末次妊娠时间>1年者误诊率53.33%(8/15),6月～1年者误诊率8.18%(2/11),<6月者误诊率0。39例患者总完全缓解率为76.92%(30/39),首诊确诊者完全缓解率88%(22/25),首诊误诊者完全缓解率57.14%(8/14);确诊时血β-HCG值≤105 mIU/ml者的完全缓解率为100%,>105 mlU/ml者的完全缓解率为65.38%(17/26);以上所有差异均有统计学意义(P<0.05)。结论:Ⅳ期滋养细胞肿瘤的首诊误诊率高与其症状无特异性和临床医师认识不足有关且影响预后,应提高临床医师的认识降低误诊率。
Objective: To analyze the diagnosis and treatment of 39 cases of stage Ⅳ trophoblastic tumor and explore how to reduce the misdiagnosis rate and improve the prognosis. Methods: The diagnosis, treatment and results of 39 patients with stage Ⅳ trophoblastic tumor were retrospectively analyzed. Results: The total diagnosis rate was 64.1% (25/39) and the rate of misdiagnosis was 35.9% (14/39). The misdiagnosis rates of the first visit to Obstetrics and Gynecology and other departments and outpatient departments of People’s Hospital of Wuhan University were 0 (0/16), 76.47% (13/17) and 16.67% (1/6) respectively. The first diagnosis was accompanied by reproductive system symptoms Misdiagnosis rate was 11.11%, non-merger misdiagnosis rate was 91.67%. The first misdiagnosis rate was 53.33% (8/15) in the first trimester of pregnancy> 1 year and 8.18% (2/11) in the first trimester of pregnancy, 105 mlU / ml. All of the above statistics were statistically significant Significance (P <0.05). Conclusion: The first misdiagnosis rate of trophoblastic tumor in stage Ⅳ is related to the nonspecific symptoms and lack of understanding of clinicians, which may affect the prognosis of clinic patients. It is necessary to improve clinicians’ understanding and reduce the misdiagnosis rate.