Clinical Analysis Of 297 Cases Of Complete Hydatidiform Mole

Objective To analyze the clinical characteristics and malignant changes of complete hydatidiform mole,and to explore the risk factors of malignant changes of it.Methods Clinical data of 297 cases of complete hydatidiform mole treated and followed up in General Hospital of Ningxia Medical University and Branch from January2004 to December 2016 were retrospectively analyzed.170 patients without malignant transformation were in the non-malignant transformation group,127 patients with malignant transformation were in the malignant transformation group.Analytical indicators included occupation,age,history of pregnancy and childbirth,gestational weeks,uterine size,clinical symptoms and complications,serum beta-hCG value at first uterine curettage,uterine cavity lesion area and average value of hydatidiform mole,secondary uterine curettage and pathology,trophoblastic proliferation,clinical and malignant features of complete hydatidiform mole after comprehensive"second child",time and characteristics of diagnosis of gestational trophoblastic tumor.SPSS 21.0 software was used to compare the rate between the two groups was compared by?2 test,rank sum test was used for rank data or non-normal distribution data,and logistic regression analysis was used for multivariate analysis.P<0.05 was regarded as the significant difference.Results1.Farmers accounted for 42%of patients with complete hydatidiform mole,followed by non-professionals(19%).The main clinical manifestations of complete hydatidiform mole were vaginal bleeding(69%),no obvious clinical manifestations(19.5%),Luteinized ovarian cysts(15.5%),and severe vomiting,hyperthyroidism and preeclampsia(3%).The median menopause days were 60 days(about 9 weeks),and 90.2%of the patients were diagnosed within 12 weeks.2.There were no significant differences in the proportion of complete hydatidiform mole over 35 years old,no significant clinical manifestations(except menopause),the proportion of luteinized cysts and malignant transformation rate after the comprehensive"two-child"policy(p>0.05).3.Univariate analysis showed that malignant transformation of complete hydatidiform mole was associated with age(?35 years old),number of pregnancies(?3 times),uterus significantly larger than menopausal gestational week(?4 weeks),luteinized cyst of ovary,serum?-hCG value>10~5IU/l at the first uterine clearance,size of hydatidiform mole uterine cavity lesion at the first uterine clearance(including the area of two maximal diameter lines of uterine cavity lesion,average value and average value(?5.5cm),with significant difference(p<0.05).4.Univariate analysis showed that complete hydatidiform mole canceration was not related to the number of abortions(?3 times),gestational weeks(>12 weeks),ovarian luteinized cyst diameter(>6 cm),secondary palace clearance operation and positive secondary uterine clearance trophoblasts and preventive hysterectomy(p>0.05).5.Bivariate logistic regression analysis showed that age more than 35 years old(OR=2.310,95%CI:1.020~4.475,p=0.010),uterine enlargement significantly greater than the gestational age of menopause(OR=6.020,95%CI:2.614~13.860,p=0.000),trophoblastic moderate and severe hyperplasia(OR=9.278,95%CI:5.101~16.877,p=0.000),uterine cavity lesions were more than 5.5 cm(OR=2.033,95%CI:1.123~3.680,p=0.019)were high risk factors for malignant transformation of complete hydatidiform mole.6.The diagnostic time and characteristics of gestational trophoblastic tumors after hydatidiform mole:65.6%of patients with complete hydatidiform mole were diagnosed within 60 days after the first uterine curettage.The median days of malignant transformation were 37 days.At the time of diagnosis,51.2%of patients had pelvic ultrasonography suggesting local myometrial infiltration or CT suggesting pulmonary metastasis.Conclusion1.The patients with complete hydatidiform mole are mainly farmers,irregular vaginal bleeding is still the main clinical manifestation,the vast majority of patients were diagnosed in early pregnancy.2.Age(?35 years old),uterus significantly greater than the perimenopausal gestational age,uterine cavity lesions(?5.5 cm),trophoblasts moderate to severe hyperplasia are high risk factors for complete hydatidiform mole malignancy.3.The number of abortions(?3 times),gestational weeks(>12 weeks),positive trophoblasts in secondary uterine clearance and secondary uterine clearance,combined with ovarian luteinized cyst diameter(>6 cm),and preventive hysterectomy were not associated with complete hydatidiform mole malignancy.4.Most complete hydatidiform mole patients with malignant transformation were diagnosed within 60 days after the first uterine curettage,and half of them had myometrial infiltration or pulmonary metastasis.