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關于葡萄胎,你不得不知的那些事兒!

發布時間:2020-07-07 11:08
標簽: 葡萄胎
葡萄胎是一種來源于胎盤絨毛滋養細胞的疾病,是由于妊娠后胎盤絨毛滋養細胞增生、間質水腫,而形成大小不一的水泡狀改變,水泡間借蒂相連成串,形如葡萄,也稱為水泡狀胎塊。大部分在清宮后可完全治愈,屬良性病變。...

葡萄胎是一種來源于胎盤絨毛滋養細胞的疾病,是由于妊娠后胎盤絨毛滋養細胞增生、間質水腫,而形成大小不一的水泡狀改變,水泡間借蒂相連成串,形如葡萄,也稱為水泡狀胎塊。大部分在清宮后可完全治愈,屬良性病變。我國報道的葡萄胎發病率為8/1000~1/125,不過隨著“二胎”政策的開放,葡萄胎的發病率大有上升的趨勢,這主要與產婦年齡增加,高齡產婦數量短期內顯著增多有關。所以,加強有關對葡萄胎相關知識的認知對女性優生優育有很大的現實意義,下面就和大家分享下有關葡萄胎和女性健康那些事兒。

關于葡萄胎,你不得不知的那些事兒!

一、葡萄胎的分類

森林舞会APP PUTAOTAIBINGLIXUEZHENDUANFENWEIWANQUANXINGHEBUFENXINGPUTAOTAI。WANQUANXINGPUTAOTAIDEJINGXIABINGLIXUEBIAOXIANZHUYAOWEIMISANDEZIYANGXIBAOGUODUZENGSHENGSUOZHIDEPUTAOYANGJIEGOUGAIBIAN,CHANGHUNYOUXUEKUAITUIMOSUIPIAN。BUFENXINGPUTAOTAIJINBUFENRONGMAOCHENGSHUIPAOZHUANG,HEBINGPEITAIHUOTAIERZUZHI,TAIERDUOSIWANG,QIECHANGBANYOUFAYUCHIHUANHUODUOFAJIXING,JINGXIAZHUYAOBIAOXIANZEWEIJUXIANXINGZIYANGXIBAOZENGSHENG,RONGMAODAXIAOJIQISHUIZHONGCHENGDUMINGXIANBUYIZHI,RONGMAOJIANZHINEIKEJIANZIYANGXIBAOBAOHANTI。BUFENXINGPUTAOTAIYONGYOUFUMUSHUANGFANGDERANSETI,SUOYIHUIBIAODAFUYUANYINJI、MUYUANBIAODADEYINJIJIYINp57KIP2,ERWANQUANXINGPUTAOTAIQUEFAMUYUANRANSETI,SUOYIBUBIAODAp57KIP2,GUKETONGGUOJIANCEMUYUANJIYINXIBAOZIYANGXIBAODEHEMIANYIZUHUAp57KIP2DEBIAODAYUFOULAIJIANBIEWANQUANXINGPUTAOTAIHEBUFENXINGPUTAOTAI。

二、葡萄胎的臨床表現

葡萄胎最常見的臨床表現是停經后的陰道流血,約80%~90%發生在妊娠6~16周。其他臨床表現還有:子宮明顯大于相應孕周(發生率約30%)、妊娠劇吐(發生率約8%)、卵巢黃素化囊腫(發生率約15%)、子癇前期征象—主要表現為孕早中期出現血壓升高和尿中有蛋白(發生率約為1%)。隨著早期超聲檢查和hCG測定的應用與普及,葡萄胎的早期診斷率大幅度提升,一些典型的臨床表現諸如妊娠劇吐、甲狀腺功能亢進、子癇前期征象、葡萄胎相關呼吸栓塞綜合征等已不多見。部分性葡萄胎患者由于滋養細胞絨毛水腫程度較輕,90%以上的部分性葡萄胎患者有不全流產森林舞会APP或稽留流產的表現,而異常子宮增大、妊娠劇吐、子癇前期征象、甲狀腺功能亢進等較少發生,或即使發生,其病情程度也較輕。

關于葡萄胎,你不得不知的那些事兒!

三、葡萄胎發病相關因素

1.ZHONGZUYINSU

森林舞会APP ZHUYAOJIANYUBUTONGGUOJIAHEDIQUFABINGLVDECHAYI。BEIMEIZHOUJIOUZHOUDEFABINGLVWEI 0.6‰~1.1‰,RIBENFABINGLVWEI2.0‰,DONGNANYAQITAGUOJIAJIYISELIEDEFASHENGLVWEIBEIMEIJIOUZHOUDE7~10BEI,WOGUOPUTAOTAIPINGJUNFASHENGLVWEI 0.81‰,HUANGZHONGRENPUTAOTAIDEFABINGLVMINGXIANGAOYUBAIZHONGREN。

2. YICHUANYINSU

森林舞会APP PUTAOTAICUNZAIDUOZHONGSHOUJINGXINGSHI,XINGCHENGBUTONGDEYICHUANXUELEIXING。WANQUANXINGPUTAOTAISHIFUXIQIYUAN,TONGCHANGSHIERBEITIHEXING。90%HEXINGWEI 46,XX,XIYOUYIGEKONGLUANYUYIGEDANBEITIJINGZISHOUJING,JINGZISHENFUZHIWEIERBEITI。LINGYOU 10%DEHEXINGWEI 46,XY,SHIYOUYIGEKONGLUANYULIANGGEDANBEITIJINGZIJIEHEERCHENG。BUFENXINGPUTAOTAIWEIFUXIHEMUXIQIYUAN,90%YISHANGWEISANBEITIHEXING,JIYOUYIZHENGCHANGDANBEITIJINGZI(LUANZI)HEYIGEJIANSHUFENLIESHIBAIDESHUANGBEITILUANZI(JINGZI)SHOUJINGERCHENG,HUOZHESHIYOULIANGGEZHENGCHANGDEDANBEITIJINGZIHEYIZHENGCHANGDEDANBEITILUANZISHOUJINGERCHENG。FUQINHEMUQINDESHUANGQINLAIYUANDEWANQUANXINGPUTAOTAICHANGYUJIAZUXINGFUFAXINGPUTAOTAIXIANGGUAN。SHOULEIJIAZUCHENGYUANYIFASHENGZHONGFUXINGPUTAOTAIRENSHEN。

關于葡萄胎,你不得不知的那些事兒!

3. YINSHIYUYINGYANGYINSU

森林舞会APP MOUXIEYINSHIXIGUANKENENGYUPUTAOTAIDEFASHENGYOUGUAN,BIRUYOUDIAOCHARENWEIYISHUCAIHEDAMIWEIZHUSHIDIQUDEFUNVPUTAOTAIBINGLIJIAODUO。LINGYIXIEDIAOCHARENWEIWEISHENGSU A YUHULUOBUSUDEQUEFAKENENGYUWANQUANXINGPUTAOTAIDEFASHENGYOUGUAN。DANZAIBUFENXINGPUTAOTAIDEFASHENGZHONGZEMEIYOUFAXIANZHEZHONGLIANXI。YINCI,YINGYANGZHUANGKUANGYEBEIRENWEISHIPUTAOTAIFASHENGDEGAOWEIYINSU。

4.YUNLUANFAYUZHANGAI

YUNLUANFAYUZHANGAIDAOZHIDEPUTAOTAIZHUYAOBIAOXIANZAIYOUGUOYICIPUTAOTAIRENSHENDEFUNVZAICIRENSHENSHIBULIANGSHENGYUJIEJUHUOFASHENGPUTAOTAIDEFENGXIANJUNZENGJIA;ERCIPUTAOTAIRENSHENHOUZAIHUANPUTAOTAIDEFENGXIANZENGZHI 20%~30%。65%DEPUTAOTAIHUANZHEXIANQIANYOUGUOZHISHAOYICIYISHANGDERENSHENJINGLI,CHUCIHUAIYUNJIFABINGZHEJINWEI 35%,DUOCIRENSHENHOUFABINGBILIYUANGAOYUCHUYUNFABINGZHE;QIESHANGCIRENSHENYUFABINGDEJIANGESHIJIANYUEDUAN,FABINGDEWEIXIANXINGYUEGAO,TISHILUANZIYUZIGONGNEIMOBUJIANQUAN,QIYOUKENENGFAZHANWEIRONGMAOSHUIZHONGBIANXING,JIEGUODAOZHIPUTAOTAIDEFASHENG。

5. NEIFENMIYINSU

PUTAOTAIZUOWEILIANGXINGRENSHENZIYANGXIBAOJIBING,YIBANFASHENGZAISHENGYUNIANLINGDEFUNV,ZAIJUEJINGHOUFUNVZHONGSHIJIQIHANJIANDE。YINDUBAODAOLEYIMING 60 SUIJUEJINGHOUWANQUANPUTAOTAIHUANZHEBEIWUZHENWEIJUEJINGHOUCHUXUEERYANWUZHILIAO。ZAIHUANZHENEIFENMIGONGNENGFASHENGWENLUANDE 50 SUIYISHANGDEFUNV,LUANXIBAORANSETIYICHUXIANYICHANG,YIDANRENSHENYIFASHENGZIYANGXIBAOJIBING。

四、葡萄胎為何會發生惡變?

ZIYANGXIBAOSHIRENTIJIAOWEIQITEDEXIBAO,LEISIYUZHONGLIUXIBAO,YOUZENGZHI、FENHUA、QINXIDETEDIAN,ERCHENGWEIPUTAOTAIHOUDEZIYANGXIBAO,QINSHINENGLIMINGXIANZENGQIANG,YINCI,PUTAOTAISUISHUYULIANGXING,DANJUYOUYIDINGDEEXINGQINGXIANG,KEEBIANWEIPUTAOTAIHOUZIYANGXIBAOZHONGLIU,QIZHONGWANQUANXINGPUTAOTAIDEEBIANLVGAOYUBUFENXINGPUTAOTAI。DADUOSHUZIYANGXIBAOZHONGLIUJUNJIFAYUPUTAOTAI,ZAIPUTAOTAIKUAIPAIKONGHOU,DAYUE16%~20%DEWANQUANXINGPUTAOTAIHUANZHEFASHENGJUBUQINXIXINGZIYANGXIBAOZHONGLIU,ERZAIQITARENSHENHOUHENSHAOFASHENG。BUFENXINGPUTAOTAIDEEBIANLVWEI1%~10%BUDENG。

關于葡萄胎,你不得不知的那些事兒!

五、葡萄胎發生惡變的高危因素

1. NIANLING

森林舞会APP NIANLING>40 SUIFUNVPUTAOTAIEBIANDEFASHENGJIHUIYAOBI<40 SUIDEDA2.5 BEI。DANGHUANZHENIANLING>40SUISHI,EBIANLVKEDA37%,ER>50 SUISHI,56%DEHUANZHEJIANGFAZHANWEIQINSHIXINGPUTAOTAI。ZHONGFUXINGPUTAOTAIEBIANJILVYEZENGJIA3~4 BEI。

森林舞会APP 2. XUEHCGZHI

森林舞会APP YOUYANJIUBIAOMINGPUTAOTAIQINGGONGSHUHOUJIANCEDEXUEHCGSHUZHIRUORENG>20000U/L,ZEYOU80%DEHUANZHEHUIJINZHANWEIRENSHENZIYANGXIBAOZHONGLIU,HUANYOUYANJIUFAXIANQINGGONGHOUXUEHCGXIAJIANGSUDUHUANMANRUCHAOGUO8ZHOUHUOCHIXUYANGXING、XUEHCGZHUANYINHOUZAICISHENGGAOZHEJUNRONGYIFASHENGEBIAN。

3. ZIGONGDAXIAO

ZIGONGZENGCHANGSUDUYUEKUAI,EBIANJIHUIYIYUEDA。ZIGONGDAYUTINGJINGYUEFENDEBIZIGONGYUTINGJINGYUEFENXIANGDENGDEEBIANJIHUIDA5.5 BEI。DANGZIGONGDAYUTINGJINGYUEFEN,YOUQICHAOGUOTINGJINGYUEFENDE4 BEISHIEBIANJILVMINGXIANZENGJIA。

森林舞会APP 4. LUANCHAOHUANGSUHUANANGZHONG

森林舞会APP DANGLUANCHAOHUANGSUHUANANGZHONGJIAODA,YOUQI>6cm,QIECHIXUSHIJIANCHANGERBUXIAOTUIZHE,EBIANFENGXIANZENGJIA。

5. PUTAOTAISHUIPAODAXIAO

YIXIAOPUTAOWEIZHUHEDAXIAOPUTAOJUNYOUDE,EBIANLVYUANGAOYUYIDAPUTAOWEIZHUDE,YUANYINKENENGSHI:①XIAOPUTAOSHIRONGMAOSHUIZHONGBIANXINGZHENGZAIKAISHI,ZIYANGXIBAOZENGSHENGYEJIAOWANGSHENG,EBIANJIHUIJIAOGAO;②XIAOPUTAOYIQINRUZIGONGBIXUEDOUZHONG,BUYIXIAOMIE,QIANFUZAITINEI,YIHOUFAZHANYICHUXIANEBIAN。

6. SHIFOUERCIQINGGONG

PUTAOTAIXINGERCIQINGGONG,RUOGUACHUWUZHONGRENGYOUSHAOLIANGPUTAOTAIZUZHIHUOTUIMOZHONGYOUXIAOPIANZIYANGXIBAOZHE,QIEBIANLVYAOBIGUACHUWUPUTAOTAIZUZHIYINXINGZHEWEIGAO。

六、葡萄胎的治療

PUTAOTAIZHILIAOQIANXUQUANMIANPINGGUHUANZHEQINGKUANG:SHIFOUHUANYOUPINXUE、RENSHENQIGAOXUEYAJIBINGHUOJIAZHUANGXIANGONGNENGKANGJIN。PUTAOTAIDEZHILIAOSHOUDUANZHUYAOBAOKUOFUYAQINGGONGSHU、YUFANGXINGHUALIAOHEZIGONGQIECHUSHU。

森林舞会APP 1. FUYAQINGGONGSHU

森林舞会APP PUTAOTAIZHENDUANYIJINGCHENGLI,YINGLIJIQINGGONG。ZAIQINGGONGKAISHIJIQINGGONGSHUHOUDESHUXIAOSHINEI,WEIJIANSHAOCHUXUE,KEKAOLVJINGDICUICHANSU。QINGGONGSHUHOU1ZHOUFUCHAXUEβ-HCGZHIHEPENQIANGCAICHAOYIPINGGUZHILIAOXIAOGUOYIJIYOUWUCANLIU。BUJIANYIDUIPUTAOTAIHUANZHEJINXINGYAOWUYINCHAN,ZHUYAOSHIYINWEIZIGONGPINFANQIANGLIESHOUSUOKENENGDAOZHIZHONGLIUSHUANZITONGGUOJINGMOXITONGXINGCHENGSHUANSAI,QIEYAOWUYINCHANYOUJIAOGAODEBUQUANLIUCHANFENGXIAN,YINCIKENENGXUYAOHOUXUHUALIAO。DANSHIZHONGYUNQIDEBUFENXINGPUTAOTAIHUANZHEKEKAOLVYAOWUYINCHAN,YINWEIQINGGONGSHIDETAIERBUFENZUZHIKENENGDUSAIFUYAXIYINGUAN。

森林舞会APP 2. YUFANGXINGHUALIAO

森林舞会APP WEIJINYIBUKONGZHIPUTAOTAIQINGGONGSHUHOUDEEBIANLV,Lewis DENGSHOUXIANTICHUJIANGYUFANGXINGHUALIAOYONGYUPUTAOTAI, YIGAISHANPUTAOTAIHUANZHEDEYUHOU。YUFANGXINGHUALIAOTONGCHANGDANYONGHUALIAOYAOWUZHILIAO1~2 LIAOCHENG, YIBANZAIPUTAOTAIQINGGONGQIANHUOQINGGONGHOUDANGRIHUOSHURINEIJINXING。WOGUOFUKECHANGJIANZHONGLIUZHENZHIZHINANZHICHU, YOUYIXIAGAOWEIYINSUZHIYIZHEKEXINGYUFANGXINGHUALIAO:①XUEQINGHCG DAYU1 ×105U/L;②ZIGONGDAYUTINGJINGYUEFEN;③HUANGSUHUANANGZHONGZHIJINGDAYU6 cm。ERFIGO(2000 NIAN)ZHINANJIANYI,CHULESUIFANGKUNNANDEHUANZHEWAI,QIYUPUTAOTAIHUANZHEBUTICHANGJINXINGYUFANGXINGHUALIAO。

3. ZIGONGQIECHUSHU

對于高齡患者,尤其是40歲以上已無再生育要求的患者,全子宮切除術更為合適,全子宮切除術可切除浸潤子宮肌層的滋養細胞病灶,從而降低妊娠滋養細胞腫瘤的發生率。當子宮大小小于孕14周時可以直接切除子宮。盡管子宮切除消除了子宮肌層局部浸潤的風險,但是由于存在病灶轉移的可能性,子宮切除后發生妊娠滋養細胞腫瘤的風險仍有3-5%,因此手術后仍需定期隨訪β-HCG數值的變化。
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