Wielsma Sabien, Kerkmeijer Linda, Bekkers Ruud, Pyman Jan, Tan Jeffrey, Quinn Michael
Department of Obstetrics and Gynaecology, Radboud University, Nijmigen, The Netherlands.
Aust N Z J Obstet Gynaecol. 2006 Apr;46(2):119-23. doi: 10.1111/j.1479-828X.2006.00539.x.
Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM).
Demographic factors were determined for all 344 cases with a review diagnosis of PHM, included age, history of previous hydatidiform mole, gestation length, hCG levels and compliance with follow-up.
Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue. All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation. All patients obtained normal levels within 32 weeks after evacuation of the partial hydatidiform mole. Only 63 (25.6%) patients completed the recommended follow-up program. No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour.
This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae. In contrast, no patient diagnosed with partial mole had a biochemical or clinical relapse after achieving normal levels of hCG, consistent with previous studies. Patients who have had a partial hydatidiform mole should be followed by hCG assays until normal levels are achieved and then follow-up can be safely discontinued.
对1992年1月至2001年1月在墨尔本皇家妇女医院葡萄胎登记处登记的所有患者的人绒毛膜促性腺激素（hCG）随访数据进行回顾性分析，以确定部分性葡萄胎妊娠后持续性滋养细胞疾病的风险，并审查目前部分性葡萄胎妊娠（PHM）患者的随访方案。
确定了344例经复查诊断为PHM的患者的人口统计学因素，包括年龄、既往葡萄胎病史、妊娠时长、hCG水平以及随访依从性。
344例诊断为PHM的患者中有6例需要用单药甲氨蝶呤及亚叶酸解救治疗。所有6例患者化疗后均实现并维持了完全生化缓解。对235例患者的hCG回归分析显示：225例患者在随访期间至少有一次hCG测量值正常，其中152例（64.7%）患者在清宫术后2个月内获得正常数值。所有患者在部分性葡萄胎清宫术后32周内hCG水平均恢复正常。只有63例（25.6%）患者完成了推荐的随访计划。没有hCG水平恢复正常的患者因复发性妊娠滋养细胞肿瘤而需要化疗。
本研究表明，所有部分性葡萄胎妊娠患者中有1.7%需要针对恶性后遗症进行治疗。相比之下，没有诊断为部分性葡萄胎的患者在hCG水平恢复正常后出现生化或临床复发，这与之前的研究一致。部分性葡萄胎患者应通过hCG检测进行随访，直至hCG水平恢复正常，然后可以安全地停止随访。
