完全性葡萄胎与胎儿共存临床研究

李珠玉陈海天彭软王子莲游泽山

【摘要】目的探讨完全性葡萄胎与胎儿共存(CMCF)的临床特征及妊娠结局。方法收集并分析6例CMCF的临床资料。结果6例中，体外受精-胚胎移植术后妊娠5例，促排卵治疗后妊娠1例；妊娠中期发现5例，妊娠早期发现1例；双胎之一完全性葡萄胎5例，三胎之一完全性葡萄胎1例；要求继续妊娠1例，要求终止妊娠4例，被迫终止妊娠1例。6例产妇均存活，胎儿存活1例。结论CMCF的发生可能与应用辅助生殖技术相关，其结局取决于病情发展、胎儿染色体及患者意愿。若胎儿染色体正常，且妊娠期间未出现严重母体并发症，有分娩活胎可能，但其继续妊娠的风险评估仍需进一步的研究。

【关键词】妊娠；完全性葡萄胎；双胎妊娠；多胎妊娠

收稿日期：(2015-05-23)

DOI：10.3969/g.issn.0253-9802.2015.10.012

通讯作者，李洁

Clinical study of complete hydatidiform mole and co-existing fetusLiZhuyu,ChenHaitian,PengRuan,WangZilian,YouZeshan.DepartmentofObstetricsandGynecology,theFirstAffiliatedHospitalofSunYat-senUniversity,Guangzhou510080,China

Correspondingauthor,WangZilian,E-mail:wangzilian2005@aliyun.com

Abstract【】ObjectiveTo explore the clinical characteristics and pregnancy outcomes of complete hydatidiform mole and co-existing fetus (CMCF). MethodsThe data of six CMCF women were analyzed retrospectively. ResultsAmong six CMCF women, five were pregnant after in vitro fertilization and embryo transplantation, and one after ovulation-stimulating treatment. Five patients were diagnosed with CMCF in middle pregnancy and one in early pregnancy. Five cases had twin pregnancy with complete hydatidiform mole and one was triplet pregnanct. One case insisted on continuous pregnancy, four accepted pregnancy termination and one was forced to terminate pregnancy. All six women and one fetus survived. ConclusionsThe incidence of CMCF is probably correlated with the application of assisted reproductive technology. Clinical outcomes depend on disease progression, fetal chromosome and patients’ willingness. If the fetal chromosome is normal and no serious maternal complications occur during pregnancy, the fetus may survive. However, the risk of continuous pregnancy remains to be evaluated.

【Key words】Pregnancy; Complete hydatidiform mole; Twin pregnancy; Multiple pregnancy

完全性葡萄胎与胎儿共存(CMCF)发生率为1/100 000～ 2/100 000，国内外文献多为个案报道[1]。随着辅助生殖技术的应用，CMCF相关报道逐渐增多。CMCF虽不常见，但其妊娠合并症发生率较高，临床决策较为困难。本研究分析了我院收治的6例CMCF病例，总结其临床特征，旨在为该病的早期诊断及治疗提供依据，现报告如下。

对象与方法

一、研究对象

2004年1月至2013年6月在我院诊断为CMCF的6例患者，其中体外受精-胚胎移植(IVF-ET)术后妊娠5例，促排卵治疗后妊娠1例。6例均为B超拟诊妊娠合并葡萄胎，最终均经病理活组织检查(活检)确诊为葡萄胎。

二、研究方法

收集6例CMCF患者病历资料，总结其一般情况、临床表现、诊治情况与妊娠结局。……