未经证实:侵袭性葡萄胎是妊娠滋养细胞瘤(GTN)的一种亚型,通常在葡萄胎后发生。高危GTN的子宫破裂是一种罕见且潜在的灾难性事件。对于希望保留生育能力的年轻女性,侵袭性葡萄胎穿孔伴子宫破裂的治疗尤其具有挑战性。
UNASSIGNED:我们介绍了一例22岁女性,在两次拔除磨牙后,葡萄胎快速转化。在第二磨牙撤离的21天内,血清β-hCG水平从5,718mIU/ml激增至44,617mIU/ml。超声检查显示子宫大小为9.2×8.9×7.8cm,子宫腔底部附近回声不均匀面积为6.9×5.2cm;凸前壁无正常肌层,外缘距浆膜层约0.24厘米。患者被诊断为侵袭性葡萄胎。既然她希望保持生育能力,我们提出了甲氨蝶呤(MTX)化疗方案.在计划化疗之前,她经历了突然的腹痛,并伴有76/48mmHg的血压和116bpm的脉搏率。紧急腹部超声扫描显示急性腹腔内出血(约2,000毫升),血检显示血红蛋白浓度为7.9g/dL。立即行子宫动脉栓塞术,和35mgMTX通过子宫动脉双侧给药。第二天,血清β-hCG降至83,530mIU/ml,生命体征保持稳定。七天后,患者接受了依托泊苷的组合,甲氨蝶呤,放线菌素,环磷酰胺,和长春新碱(EMACO),血清β-hCG水平在第5周期后恢复正常。在治疗完成后的13个月随访,该妇女无病,β-hCG水平正常。
UNASSIGNED:我们的经验强调了在这种情况下保守治疗保留生育力的潜在可行性和有效性。
UNASSIGNED: Invasive moles are a subtype of gestational trophoblastic neoplasia (GTN) that usually develops after hydatidiform molar pregnancies. Uterine rupture in high-risk GTN is a rare and potentially catastrophic event. The treatment of invasive mole perforation with uterine rupture is particularly challenging in young women who desire fertility preservation.
UNASSIGNED: We present the case of a 22-year-old woman with a rapidly transformed invasive mole after two evacuations for a complete molar pregnancy. Within 21 days of the second molar evacuation, the serum β-hCG level surged from 5,718 mIU/ml to 444,617 mIU/ml. An ultrasonography examination showed the uterus was 9.2×8.9×7.8 cm in size with an uneven echo area of 6.9×5.2 cm near the fundus of the uterine cavity; the convex anterior wall had no normal muscle layer, and the outer margin was about 0.24 cm from the serosal layer. The patient was diagnosed with an invasive mole. Since she desired fertility preservation, we proposed a methotrexate (MTX) chemotherapy regimen. Before the planned chemotherapy, she experienced sudden abdominal pain accompanied by a blood pressure of 76/48 mmHg and a pulse rate of 116 bpm. An emergency abdominal ultrasound scan showed acute intra-abdominal bleeding (approximately 2,000 ml), and blood tests showed a hemoglobin concentration of 7.9 g/dL. Immediate uterine artery embolization was performed, and 35 mg MTX was administered bilaterally through the uterine arteries. The next day, the serum β-hCG decreased to 83,530 mIU/ml, and the vital signs remained stable. Seven days later, the patient received a combination of etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMACO), and the serum β-hCG level normalized after cycle five. At the 13-month follow-up after therapy completion, the woman was disease-free with a normal β-hCG level.
UNASSIGNED: Our experience highlights the potential feasibility and efficacy of conservative treatment for fertility preservation in such scenarios.