最新妇产科精品课件-妊娠滋养细胞疾病(英文)-药学医学精品资料.ppt

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1、最新妇产科精品课件-妊娠滋养细胞疾病(英文)-药学医学精品资料ClinicalFeaturesofGTN非转移GTN:(Non-metastaticDisease)阴道出血／继发贫血；子宫增大；卵巢黄素化囊肿急腹症：子宫穿孔／继发感染／囊肿扭转／囊肿破裂假孕症状转移性GTN(MetastaticDisease)肺－80％阴道－30％盆腔－20％肝－10％脑－10％，为主要死因其他－脾／肾／消化道／骨等可仅表现为转移灶症状；转移部位局部出血TheStagingofGTN（FIGO2000）ModifiedWHORiskFactorScoringSyste

2、mLow-risk:<7.High-risk:≥7.Chemotherapy(Curerate92%)Lowrisk－singledrug,i.e.MTXorAct-DorVP-16.Highriskorresistance－EMA-CO,orbasedon5-FuRegression－疗程结束18天内血-hCG下降至少1个对数停药指征－低危：血-hCG连续3周阴性后＋1疗程高危：血-hCG阴性，症状体征消失＋2~3疗程手术／放疗为辅Salvagechemotherapy：EP-EMA，PVB，BEP，VIP等ManagementofGTNEMA

3、/COEtoposide,high-doseMethotrexatewithcitrovorin(folinicacid)rescue,ActinomycinD,Cyclophosphamide,Vincristine[Oncovin])Surgery：Hysterectomy.Surgicalremovaloflesionsinuterus.Pulmonarylobectomy.RadiationFormetsintheliverorbrainForchemo-resistantlesioninthelungManagementofGTN(Cont.

4、)Follow-upofGTNSimilartohydatidiformmole；Timetovisit：Everymoninthefirst3mons.Every6monstill1y.Onceayeartill5y.Every2ythereafter…PSTTRarelyseenGoodprognosisThemassmayprotrudeintotheuterinecavity,orlimitedinthemyometrium.中间型滋养细胞，无绒毛结构IHC:hCG＋，hPL＋SonographicappearanceofPSTTNonspec

5、ific,similartouterinemyomaandotherGTT.ManagementofPSTTHistologicexamisnecessary.Hysterectomyisthefirstchoice.EMA-COisrecommendedforthosewithhighriskfactors.Highriskfactors：MI>5/HPIntervalmonthsfromindexpregnancy>24ExtrauterinemetastasisSummary妊娠滋养细胞肿瘤（GTN）包括侵蚀性葡萄胎和绒毛膜癌，胎盘部位滋养细胞肿

6、瘤（PSTT）为一特殊类型GTT。除子宫病灶症状外，还需注意转移症状诊断主要根据血-hCG等辅助检查，组织学依据非必需是化疗能达治愈的肿瘤对非转移或低危型转移者，单药化疗即可显效Quiz&DiscussionQUIZ下列哪种情况需考虑GTD的可能性？A.Persistentabnormalbleedingfollowingnormalpregnancy,abortion,orectopicpregnancy.B.Thefindingofpulmonarynodulesonchestradiographafternormalpregnancy.C.Ay

7、oungwomanwithanunknownprimaryneoplasm.D.Ayoungwomanwithpoorlyexplainedhyperthyroidism.GTD最常继发于下列哪种情况？A.MolarpregnancyB.NormalpregnancyC.AbortionD.Ectopicpregnancy.监测和随访GTD时需检测下列哪个指标？A.CA125B.β-HCGC.AFPD.hPL下列叙述哪些是正确的？A.Partialmolesareofpaternalorigin,arediploid,andcarrya20%risko

8、fGTDsequelae.B.Completemolesareofmaternalandpat