Objective To analyze the high risk factors of malignant transformation of hydatidiform mole(HM)and effects of preventive chemotherapy and operation. Methods Total 248 patients with HM receiving treatment in our hospital from June of 2005 to June of 2013 were surveyed,respectively. The survey indexes included the patientsˊage,relationship between the uterine size and the pregnancy,serum human chorionic gonadotropin levels,ovarian lutein cyst size,whether or not HM occurred repeatedly,and high risk factors of malignant transformation of HM,etc. All patients received uterine aspiration therapy;those who had one of the high risk factors but had no follow-up conditions received preventive chemotherapy;those who were more than 40 years old,had no fertility requirements and had high risk factors of malignant transformation but no follow-up conditions received hysterectomy. Results The ratio of malignant transformation of HM of the patients having high risk factors( more than 40 years old;the uterus was larger than that in the corresponding month of menopause,the value of serum hCG was higher than 105 U/L,and the diameter of ovarian lutein cyst was equal to or greater than 6 cm;having a history of HM)was significantly higher than that of those who had no high risk factors(P<0. 05),but the degrees were different,and the ratio of those whose diameter of ovarian lutein cyst was equal to or greater than 6 cm was the highest. The ratio of malignant transformation of the patients who had received preventive chemotherapy or operation was 8. 3% and 3. 3%, respectively,significantly lower than those receiving no preventive chemotherapy or operation of 35. 9%(P<0. 05). Conclusion The high risk factors lead to a significantly increased ratio of malignant transformation of HM,but the degrees are different;preventive chemotherapy or operation can reduce the incidence of malignant transformation of HM of the patients with high risk factors.%目的对葡萄胎恶变的高危因素和预防性化疗与手术效果进行分析。方法对2005年6月~2013年6月收治的248例葡萄胎患者进行回顾性调查。调查指标包括患者年龄、子宫大小与孕期的关系、血清人绒毛膜促性腺激素水平、卵巢黄素化囊肿的大小、葡萄胎是否重复发生和葡萄胎恶变的高危因素等。所有患者均行吸宫术治疗，有高危因素之一并无随访条件者行预防性化疗；年龄≥40岁、无生育要求、有恶变高危因素或无随访条件者行全子宫切除。结果有高危因素（年龄40岁以上，子宫大于相应停经月份，血清hCG值≥105 U/L，卵巢黄素化囊肿直径≥6 cm，既往有葡萄胎病史）患者的葡萄胎恶变率均显著高于无高危因素的患者（P<0.05），但程度有所不同，卵巢黄素化囊肿直径≥6 cm者恶变率最高。进行了预防性化疗或预手术患者的恶变发生率分别为8.3%和3.3%，显著低于未行预防性化疗或手术的患者的35.9%（P<0.05）。结论各种高危因素均导致葡萄胎恶变率显著升高，但是程度不同；有高危因素患者行预防性化疗或手术可以明显地降低恶变发生率。
展开▼
