Value Of Hysteroscopy In Diagnosis And Treatment Of Gestational Trophoblastic Disease

Objective: To evaluate the role of hysteroscopy in the diagnosis,treatment,prognosis and the identification of myometralinvation process of gestational trophoblastic disease.Methods: Retrospective analysis, 30 patients who were diagnosed and treated as GTD in our hospital from April 2004 to January 2010, their clinical diagnostic hysteroscopy were analyzed.Hysteroscopy equipment: Germany WOLF TV intrauterine device inspection system, outside the sheath for the 5mm, automatic expansion Palace device, uterine distention pressure (80 ~ 90) mmHg, uterine distention media for the 5% glucose solution, solution flow rate of uterine distention (250 ~ 300) mL / min. Japan sony color monitor, HP LOGIQ200 type B mode ultrasound scanner.Hysteroscopy Methods: Patients were bladder lithotomy position, conventional disinfection shop towels, disinfecting the vagina, cervix, connected hysteroscopy, hysteroscopic placement, the order observed by the uterus before and after the uterine wall and the end of Palace angle, the last observation cervical. Dynamic observation combined B-scan, hysteroscopy and uterine distention fluid and urine in the bladder ultrasound contrast dark area under the double. Using hysteroscope intrauterine situation, B ultrasonography myometrium points of light density, shape.Hysteroscopy findings: 30 cases of patients with GTD under the combination of B-mode ultrasonography with hysteroscopy is divided into the following seven kinds of situations: (1) mole residue: we can see a small blister-like intrauterine tissue residue, blister-like tissue has nothing to do with the myometrium under the ultrasonography; (2) GTN lesions associated with muscle: the intrauterine see blister-like tissue connected with the myometrium, we can see the corresponding muscle imbalance under ultrasonography; (3) GTN muscle layer lesions: Purple-blue intrauterine lesions in the muscle, ultrasonography see the corresponding muscle uneven; (4) GTN incomplete perforation: Uterine rupture can be seen within the cavity, which can be seen within the necrotic mass extrusion, See convex mass over the next connected with the Palace under the ultrasonography, which can enter inside the perfusate; (5) PSTT muscular lesion: purple nodules were prominent muscle surface, the rich vascular; (6) GTN without intrauterine lesions : no significant lesions within the uterine cavity, ultrasonography under the see the border without hyperechoic mass envelope, or to see the border was unclear and no lumps or uneven envelope of the echo area, but also showed the uterus diffuse increase in echo, which with irregular hypoechoic or anechoic; (7) normal uterine cavity: the normal uterine cavity after curettage of hydatidiform mole,with no residue.Results: (1) mole Group Results: 13 cases of hydatidiform mole before hysteroscopy patient had a history of uterine curettage, curettage 1-3 times, 9 cases had mole residue which was removed under the hysteroscopy , pathology results confirmed hydatidiform moles block; four cases of normal uterine cavity after curettage for the mole. HCG levels in patients with a steady decline, the Qing HCG test after 14 weeks were normal. (2) GTN Group Results: 17 patients with GTN group were divided into two groups according to treatment, surgical removal of the uterus in 6 cases; line conservative treatment, 11 patients received chemotherapy alone.â‘ hysterectomy group results: combined ultrasonography with hysteroscopy we found that 2 patients in the hysteroscopy the uterine tissue and muscle within the blister-like connected, we can see the corresponding muscle imbalance under ultrasonography, hysteroscopic diagnosis was the invasive mole, pathology confirmed; two cases of uterine Purple-blue lesions in muscular, we can see the corresponding muscular uniform, hysteroscopic diagnosis was invasive mole, surgery pathological findings confirmed; 2 cases purple nodules prominent muscle surface, rich blood vessels, hysteroscopic diagnosis was PSTT, pathology results to confirm. 6 patients, diagnosis of hysteroscopy,surgical hysterectomy pathology results and clinical diagnosis was 100%.â‘¡results of conservative treatment group: 11 cases with conservative treatment, only chemotherapy, 2 patients had 2 or more hysteroscopy, hysteroscopy combined with ultrasound after chemotherapy were significantly reduced visible lesions, 1 patient underwent uterine cavity in the second chemotherapy microscopic examination of intrauterine purple nodules, ultrasonography see no abnormal muscle, and the other a routine three times hysteroscopy, in the former two cycle of chemotherapy lesions were found, in the third cycle, intrauterine lesions completely disappeared, and ultrasonography result is normal. 11 patients were cured, continue to follow-up. None of 30 patients with hysteroscopy complications arise.Conclusion: 1, Hysteroscopy combined with B-mode ultrasonography can be used for diagnosis of GTD, safe and effective.2, Hysteroscopy can be used for diagnosis of mole residue after curettage, may be used to remove the mole residue compeletely, reduce the number of unnecessary curettages, reduce endometrial damage.3, Diagnostic hysteroscopy on the GTN is meaningful, can detect invasive early lesions of the myometrium. For confirmed cases, hysteroscopy for the observation of secondary effects of chemotherapy, can provide a more precise comparison of data on treatment outcome and prognosis of patients with a reference value.