Clinical Analysis Of 55 Cases Of Gestational Trophoblastic Diseases

Objectives:Through retrospective analysis of the clinical cases of gestational trophoblastic disease,to explore the relevant factors affecting the prognosis of the disease and to summarize clinical experience and insufficient in diagnosis and treatment?Methods:1.A Retrospective analysis of 55 cases of gestational trophoblastic diseases in the Department of Obstetrics and Gynecology of Changhai Hospital of Naval Military Medical University from 2009 to 2016.GTN patients were grouped according to FIGO staging and classification and FIGO/WHO scoring system based on prognostic factors.2.Analyze the relationship between the times of evacuation of hydatidiform mole and the time of HCG returning to normal by chi-square test.3.Compare gestational trophoblastic neoplasia patients treated by chemotherapy only or chemotherapy and surgery with the time of HCG returning to normal by chi-square test.4.Analyze the therapeutic effects of different chemotherapy regimens in the initial treatment of low-risk and high-risk GTN patients;5.Use Kaplan Meier survival analysis and Cox regression analysis to analyze the relationship between clinical characteristics and cure time of GTN patients;Result:1.The patients who evacuation twice or more than twice can't shorten the time of HCG returning to normal than who evacuation only once(P=0.453).There is one patient who evacuation only once of HCG returning to normal within 4 weeks and 10 cases use >4 weeks to return to normal.Two patients who evacuation more than twice use within 4 weeks to return HCG to normal while 13 cases use >4 weeks.2.The patients who treat by chemotherapy and surgery don't shorten the time of HCG returning to normal than by chemotherapy alone(P = 0.599).The patients treaded by chemotherapy alone,the time of blood HCG conversion was less than or equal to 4 weeks in 7 cases and >4 weeks in 8 cases.In contrast,chemotherapy with surgery's patients had HCG negative in 4 cases for 4 weeks and >4 weeks in 7cases.3.In the low-risk group,the effective rate of single-agent treatment for initial treatment was 66.7%(2/3),and the multi-drug combination effective rate was 100%(7/7).The effective rate of single-drug treatment in patients with high-risk GTN chemotherapy was 75%(3/4),and the combined drug use rate was 83.3%(10/12).4.Univariate analysis showed that term delivery and abortion were related to complete relief(P<0.05).Cox multivariate analysis showed that term delivery(P = 0.020)was an independent factor in the complete relief of GTN.Kaplan-Meier survival analysis found that women age(P = 0.043),term delivery(P = 0.016),and abortion(P = 0.026)were accociated to GTN chemotherapy complete relief time.5.Excluding patients >40 years of age without fertility requirements,the rate of re pregnancy after hydatidiform mole was 31.8%,and the rate of re-pregnancy of GTN was 6.9%.Conclusion:1.Increase the number of evacuation does not shorten the time of HCG returning to normal,so patients with hydatidiform moles are diagnosed promptly for evacuation,but if there is no persistent bleeding,second evacuation is usually not required.2.Surgery and chemotherapy to treat GTN patients compared with chemotherapy alone can not significantly shorten the time of HCG returning to normal,so GTN patients are still the first choice for chemotherapy,surgery may be beneficial to some patients,but not for all patients,the clinical need to strictly control Surgical indications.3.Risk factors for gestational trophoblastic neoplasia include age,term delivery and abortion,women with these should be vigilant against the occurrence of gestational trophoblastic disease.The healing time is long and the dynamic changes of blood hCG should be closely monitored.4.Symptoms of gestational trophoblastic tumor patients are not typical,clinical performance are various,while pregnancy-related diseases should be considered,gestational trophoblastic diseas also should not be forgetten,as for as possible to avoid missed diagnosis,misdiagnosis.5.Inadequate: This study is a retrospective analysis,while the number of cases is small and some chemotherapy is not standardized,it may affect the statistical analysis,the results need to further expand the sample size analysis to verify.