国际妇产科学杂志

国际妇产科学杂志 ›› 2025, Vol. 52 ›› Issue (5): 505-507.doi: 10.12280/gjfckx.20250317

• 妇科肿瘤研究: 病例报告 • 上一篇    下一篇

剖宫产瘢痕妊娠合并绒毛膜癌一例

和雪琴(), 和丽, 张昌勇, 赵捷   

  1. 674100 云南省丽江市人民医院（和雪琴，和丽，张昌勇）；北京大学第三医院生殖医学中心（赵捷）
  • 收稿日期:2025-03-27 出版日期:2025-10-15 发布日期:2025-10-16
  • 通讯作者: 和雪琴 E-mail:1025134120@qq.com
  • 基金资助:
    2024年度云南省中青年骨干医师研修项目(云卫人发〔2024〕5号);昆明理工大学医学联合专项面上项目(KUST-LJ2022003Y)

A Case of Cesarean Scar Pregnancy Complicated with Choriocarcinoma

HE Xue-qin(), HE Li, ZHANG Chang-yong, ZHAO Jie   

  1. Lijiang People's Hospital, Lijiang 674100, Yunnan Province, China (HE Xue-qin, HE Li, ZHANG Chang-yong); Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China (ZHAO Jie)
  • Received:2025-03-27 Published:2025-10-15 Online:2025-10-16
  • Contact: HE Xue-qin E-mail:1025134120@qq.com

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摘要：

绒毛膜癌是一种高度恶性、早期易转移的妊娠滋养细胞肿瘤。剖宫产瘢痕妊娠合并绒毛膜癌临床症状缺乏特异性，临床上极为罕见，早期易误诊，早期诊断和治疗对预后至关重要。报告1例剖宫产瘢痕妊娠合并绒毛膜癌病例，患者因停经59 d伴阴道出血2 d入院。行宫腔镜下瘢痕妊娠物清除术后病理确诊为剖宫产瘢痕妊娠。术后复查血清人绒毛膜促性腺激素β亚单位（β-human chorionic gonadotropin，β-hCG）水平下降后异常复升，超声提示瘢痕处异常回声团，疑诊滋养细胞疾病，行腹腔镜下剖宫产瘢痕妊娠病灶切除术后病理确诊为绒毛膜癌。患者经过2个疗程的氟尿嘧啶+放线菌素-D+长春新碱（FAV）方案化疗后，复查血β-hCG转阴性，经阴道超声检查未见异常包块，化疗结束后随访11个月未复发。

关键词: 剖宫产术, 瘢痕, 妊娠, 绒毛膜癌, 甲氨蝶呤, 腹腔镜检查

Abstract:

Choriocarcinoma is a highly malignant gestational trophoblastic tumor that is prone to early metastasis. Cesarean scar pregnancy complicated with choriocarcinoma lacks specific clinical symptoms, is extremely rare clinically, and is easily misdiagnosed in the early stage. Early diagnosis and treatment are crucial for the prognosis. A case of cesarean scar pregnancy complicated with choriocarcinoma is reported. The patient was admitted to the hospital due to amenorrhea for 59 days accompanied by vaginal bleeding for 2 days. After hysteroscopic removal of the scar pregnancy tissue, the pathological diagnosis was cesarean scar pregnancy. After the operation, the serum level of β-human chorionic gonadotropin (β-hCG) decreased and then abnormally increased again. Ultrasound showed an abnormal echo mass at the scar site, and gestational trophoblastic disease was suspected. After laparoscopic resection of the cesarean scar pregnancy lesion, the pathological diagnosis was choriocarcinoma. After two courses of chemotherapy with the fluorouracil + actinomycin-D + vincristine (FAV) regimen, the patient's blood β-hCG turned negative. Transvaginal ultrasound showed no abnormal mass. The patient had no recurrence during the 11-month follow-up after the end of chemotherapy.

Key words: Cesarean section, Cicatrix, Pregnancy, Choriocarcinoma, Methotrexate, Laparoscopy