Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan.
Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan.
Taiwan J Obstet Gynecol. 2019 Sep;58(5):650-655. doi: 10.1016/j.tjog.2019.07.012.
Suction curettage is recommended for molar evacuation rather than sharp curettage because of its safety. However, the superiority of suction curettage with respect to the incidence of gestational trophoblastic neoplasia (GTN) has not been reported. This study aimed to compare the efficacy and safety of two evacuation procedures, vacuum aspiration and forceps/blunt curettage, for complete hydatidiform moles (CHMs) to determine the differences between them.
Patients with androgenetic CHM determined by multiplex short tandem repeat polymorphism analysis were included in this observational cohort study. Patients underwent evacuation with forceps and blunt curettage (forceps group) before March 2013 and with vacuum aspiration (vacuum group) thereafter. GTN was diagnosed based on the International Federation of Gynecology and Obstetrics 2000 criteria. The incidence of GTN and other clinical parameters were compared.
Ninety-two patients were diagnosed with androgenetic CHM. The number of patients in the forceps and vacuum groups was 41 and 51, respectively. The incidence of GTN was 12.2% (5/41) and 13.7% (7/51) in the forceps and vacuum groups, respectively, which was not significantly different (P = 1, Fisher's exact test). No major adverse events, such as uterine perforation and blood transfusion, were noted in either group. The median surgery time was shorter in the vacuum group (16 min) than in the forceps group (25 min) (P = 0.05, Mann-Whitney U test).
There were no differences in the incidence of GTN between the forceps and vacuum groups for androgenetic CHM. However, vacuum aspiration could have the advantage of a shorter surgery period. The use of vacuum aspiration for molar pregnancy seems to be safer. Therefore, we recommend suction curettage for the first evacuation of hydatidiform moles.
由于安全性，推荐使用吸引刮宫术而非锐刮术来进行中晚期妊娠的清除。然而，尚未有报道表明吸引刮宫术在妊娠滋养细胞肿瘤（GTN）发生率方面具有优势。本研究旨在比较两种清除完全性葡萄胎（CHM）的手术方式——吸引刮宫术和钳刮术的疗效和安全性，以确定两者之间的差异。
本观察性队列研究纳入了经多重短串联重复序列多态性分析诊断为完全性葡萄胎的患者。患者在 2013 年 3 月之前采用钳刮术和钝刮术（钳刮组）进行清除，此后采用吸引刮宫术（吸引组）。GTN 的诊断依据国际妇产科联合会 2000 标准。比较 GTN 发生率和其他临床参数。
92 例患者被诊断为完全性葡萄胎。钳刮组和吸引组患者的数量分别为 41 例和 51 例。钳刮组和吸引组的 GTN 发生率分别为 12.2%（5/41）和 13.7%（7/51），差异无统计学意义（P=1，Fisher 确切概率法）。两组均未发生子宫穿孔和输血等严重不良事件。吸引组的手术时间中位数（16 分钟）较钳刮组（25 分钟）短（P=0.05，Mann-Whitney U 检验）。
在完全性葡萄胎中，钳刮术和吸引刮宫术的 GTN 发生率无差异。然而，吸引刮宫术可能具有手术时间更短的优势。对于葡萄胎妊娠，使用吸引刮宫术似乎更安全。因此，我们建议在首次清除葡萄胎时使用吸引刮宫术。
