潘丽 张丽华 贠小巧 赵丽娟 施艳茹 卢晔 庞丽萍

【摘 要】胎盘部位滋养细胞肿瘤（placental site trophoblastic tumor，PSTT）是临床较罕见的一种妊娠滋养细胞疾病，其来自胎盘种植部位，与侵蚀性葡萄胎和绒癌相比，其病理形态、病程进展及治疗方式的选则均不同。常见症状为阴道不规则流血及无明显诱因的停经，多继发于流产、葡萄胎或足月妊娠后，体征为子宫均匀性或不规则增大，因其症状体征不典型，容易误诊。血清人绒毛膜促性腺激素（hCG）可升高或正常。PSTT绝大多数发生于生育期年龄，平均发病年龄为31岁～35岁，绝经后较为罕见。因超声检查无特异性表现，故其确诊主要靠组织病理学。现将我院收治的1例PSTT患者相关情况总结成文，结合其他研究及报道，整理探讨该病的临床特征、诊断、治疗等相关要点，以期为以后临床诊治提供可靠信息。

【关键词】胎盘部位滋养细胞肿瘤；临床特征；诊断；治疗

A case report of trophoblastic tumor in the placenta

Pan Li，Zhang Lihua，Yun Xiaoqiao，Zhao Lijuan，Shi Yanru，Lu Ye，Pang Liping

Department of Gynecology， Yinchuan Traditional Chinese Medicine Hospital， Yinchuan Ningxia 750001， China

【Abstract】Placental site trophoblastic tumor （PSTT） is a rare clinical gestational trophoblastic disease. It comes from the placental implantation site. Compared with invasive mole and choriocarcinoma， its pathological morphology， course of disease progress and the selection of treatment are different. The common symptoms are irregular vaginal bleeding and menopause without obvious inducement. Most of them are secondary to miscarriage， mole or full-term pregnancy. The signs are the uniformity or irregular enlargement of the uterus. Because of its atypical symptoms and signs， it is easy to be misdiagnosed. Serum human chorionic gonadotropin （hCG） can be elevated or normal. The vast majority of PSTT occurs at the reproductive age， the average age of onset is 31～35 years old， and it is rare after menopause. Because ultrasound has no specific findings， the diagnosis is mainly based on histopathology. The relevant information of 1 PSTT patient admitted to our hospital is summarized and written， combined with other studies and reports， to sort out and discuss the clinical features， diagnosis， treatment and other related points of the disease， in order to provide reliable information for future clinical diagnosis and treatment.

【Key？Words】Placental trophoblastic tumor； Clinical features； Diagnosis； Treatment

患者女 32歲。以“月经紊乱3个月，阴道不规则流血19天。”于2020年12月27日入院，血hCG：9446 mIU/mL，B超：子宫左侧壁近宫角处混合回声团（内膜0.7cm，于子宫肌层左侧壁近宫角处可见一大小约2.0cm×1.7cm混合回声团，边界清，形态规则，内部回声不均匀，略向外凸。以（1）停经阴道流血待查，①左侧宫角妊娠？②左侧输卵管间质部妊娠？③妊娠滋养细胞疾病？（2）宫内节育器，收住入院。入院后胸部CT未见异常，给予甲氨蝶呤肌肉注射+米非司酮口服+中药治疗，一周后（2021年1月4日）血hCG：4921.00 mIU/ml，B超：内膜0.7cm，子宫肌层左侧壁距宫角处约0.3cm处探及一大小约1.5cm×1.4cm混合回声团，与内膜线不连续。宫腔镜检查：双侧输卵管开口可见，左侧宫角未见妊娠组织，刮宫并取环。……