Disease name:
Introduction:
The blister-like tissue of the hydatidiform mole has exceeded the scope of the uterine cavity, and it has been invaded into the deep part of the myometrium or metastasized in other parts, called malignant mole. The chance of occurrence is 5% to 20% of vitiparous malignant moles or choriocarcinoma, most of which occur within 6 months after the hydatidiform mole is removed, but there are also malignant changes before the hydatidiform moles are discharged. Although malignant hydatidiform mole has the characteristics of malignant tumor, the therapeutic effect and prognosis are better than that of choriocarcinoma.
Cause:
The exact cause of malignant moles is unclear. Various explanations have been proposed in the literature, such as early embryonic death, second polar body replication theory, nutritional factors, viral infection theory, etc., but there is no conclusive evidence. Some scholars believe that the occurrence of hydatidiform mole is related to chromosomal abnormalities.
symptom:
The main symptom of malignant moles is that within a few months after the discharge of the moles, irregular vaginal bleeding occurs, and the amount is uncertain. The uterus is slightly larger and softer, such as uterine perforation, abdominal pain, internal bleeding, and even shock. The hydatidiform mole can be transferred to the lungs to have hemoptysis; if it is transferred to the brain, it will appear and hemorrhage symptoms, or even die immediately; transfer to the intestine can cause gastrointestinal bleeding; transfer to the vulva, vagina and cervix, local blue nodules, Nodules can cause major bleeding.
diagnosis:
1. Urine pregnancy test: After more than 2 months after the emptying of the hydatidiform mole, it is confirmed by the curettage that there is no residual blister-like block, and the urine pregnancy test is still positive, or negative and then positive, and there is malignant possibility.
2. X-ray chest X-ray: Malignant hydatidiform moles can often occur in the lungs. Therefore, for cough and hemoptysis, lung examination must be performed. It can be seen that cotton-like shadows are scattered throughout the lungs, especially in the right lung. Lower leaves. However, those without lung disease cannot rule out erosion of the mole.
3. Diagnostic curettage: If only vaginal bleeding, other symptoms and signs are not typical, can be used for diagnostic curettage, if a small amount of decidua or necrotic tissue is scraped, the aggressive mole can not be ruled out.
Identification
1. Abortion: The history of hydatidiform mole is similar to that of threatened abortion. It is easy to be confused. Threatened abortion has symptoms such as menopause, vaginal bleeding and abdominal pain. The pregnancy test is positive. However, most of the uterus of the hydatidiform mole is greater than the normal pregnancy of the corresponding gestational age, the HCG level continues to be high, and the B-mode ultrasound image does not show the fetal sac and fetal heartbeat, but shows the characteristics of the hydatidiform mole.
2. Twin pregnancy: The uterus is larger than the normal singleton pregnancy of the corresponding gestational age. The HCG level is also slightly higher than normal. It can be confused with the hydatidiform mole, but there is no vaginal bleeding in the twin pregnancy. B-mode ultrasonography can confirm the diagnosis.
3. Too much amniotic fluid: generally occurs during pregnancy. If it occurs in the second trimester, the factor palace rapidly increases and needs to be differentiated from the mole. There is no vaginal bleeding when the amniotic fluid is too much, the HCG level is in the normal range, and B-mode ultrasonography can confirm the diagnosis.
complication:
If uterine perforation occurs, there is abdominal pain, internal bleeding, and even shock. The hydatidiform mole can be transferred to the lungs to have hemoptysis; if it is transferred to the brain, it will appear and hemorrhage symptoms, or even die immediately; transfer to the intestine can cause gastrointestinal bleeding; transfer to the vulva, vagina and cervix, local blue nodules, Nodules can cause major bleeding.
treatment:
Western medicine treatment
Surgical treatment:
First, the Qing Palace may have major bleeding at any time due to the hydatidiform mole. Therefore, after the diagnosis is confirmed, the contents of the uterus should be removed in time, and the suction surgery is generally used. During the aspiration of the contents, the uterus gradually shrinks and hardens. Although the aspirate contains more blood, most of the blood is in the uterine cavity, so the pulse and blood pressure of the patient generally do not change much. Many people advocate that if the uterus exceeds the umbilicus, the hydatidiform mole should be administered through the abdominal section, which is considered to be completely removed under direct vision and can stop bleeding better. However, in practice, even if the uterus swells to the greater than seven or eight months of pregnancy, the application of aspiration can be successfully removed. If you need to remove the uterus, you can do it immediately after inhaling the palace. The cesarean section takes the hydatidiform mole and causes the grape to grow and transfer. Those who do not have suction equipment can clamp the moles after expanding the cervix.
For the first time, the Qing Palace does not have to be too thorough, so that it damages the softer walls. You can do a second curettage in about 1 week.
Often patients who have undergone uterine cures and who have uterine bleeding are treated according to the situation. Suspected that the incomplete abortion of the hydatidiform mole (incomplete suction or new blister), can be carefully cured, such as still bleeding, should consider the lesion into the palace wall, see malignant mole and choriocarcinoma. The spontaneous abortion of the moles should also be cleared. There is a different opinion on whether or not intravenous infusion of uterine contraction agents during the Qing Dynasty. Opposing users that uterine contractions cause strong contraction of the uterus can force the vitreous fluff into the blood circulation, causing embolism or grape fluff to enter the blood circulation, causing embolism or metastasis. Therefore, during the operation, if the uterus contracts well, it is not necessary to routinely apply the uterotonic agent, and it is only applied when the bleeding is more and the uterus contracts poorly.
Second, the age of hysterectomy is more than 40 years old, or the mother's uterus grows faster, should be advised to remove the uterus, young may consider keeping the ovaries. Patients with uterus greater than 5 months of pregnancy should be removed by vaginal removal of most of the vesicular blocks in the uterine cavity for surgical treatment.
Third, the heavier blood transfusion should be given a small number of slow blood transfusions, and closely observe whether the patient has active bleeding, until the situation is improved to a certain extent before the implementation of Qinggong. In the event of active bleeding, blood transfusion should be given at the same time as the Qing Palace.
Fourth, to correct electrolyte imbalance Long-term bleeding, loss of appetite often have dehydration, electrolyte imbalance, should be checked and corrected.
Fifth, control the long-term bleeding of infected uterus, or after repeated unclean operation, it is easy to cause infection, manifested as local (uterus or attachment) infection or sepsis. Adequate anti-inflammatory drugs should be given; and anemia and electrolyte disorders should be actively corrected.
The above content is for reference only, please consult the relevant physician or relevant medical institution if necessary.
prevention:
To prevent malignant transformation after hydatidiform mole surgery, there is no ideal method so far, but preventive chemotherapy for high-risk patients with malignant tendency may reduce the occurrence of malignant transformation. Prophylactic chemotherapy can be taken when the age is greater than 40 years, the uterus is significantly larger than the month reached or exceeds 5 months, the abnormal increase in HCG value is greater than 105 IU/L, and the family is difficult to follow. Prophylactic chemotherapy should start 2 to 3 days before the curettage. In the curettage, it is found that the hydatidiform mole is mainly small blisters, or pathological examination shows that the trophoblast cells are highly proliferated, or accompanied by dysplasia, or the HCG after the curettage drops to a certain high value, no longer continue to decline, can be taken Selective chemotherapy also has the effect of reducing malignant transformation.
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