胞状奇胎後管理基準の設定に関する研究

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  • A study on a New Follow-up System of Postmolar Pregnancy

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1983年より1990年までの8年間に千葉大学産婦人科で管理した胞状奇胎491例を対象とし,奇胎除去後血中human chorionic gonadotropin (hCG)値の推移をレトロスペクティブに検討して以下の結果を得た。また正常非妊娠婦人120例において血中hCG倍のcut-off値を検討した。(1)血中hCG値のcut-off値は95パーセンタイルより5.0mIU/mlに設定された。(2)奇胎除去後経過順調型の410例を対象に奇胎除去後の週数と血中hCG値を比較すると408例において5週10,000mIU/ml,8週1,000mIU/ml,15週100mIU/mlの基準を下回った。(3)侵入奇胎54例では前記の基準を全例が上回った。(4)奇胎除去後15週で血中hCG値がcut-off値以上を示した43例中5例(11.6%),20週では12例中4例(33.3%),24週では7例中3例(42.9%)が絨毛癌を続発した。(5)以上より奇胎除去後の血中hCGの基準を5週10,000mIU/ml,8週1,000mIU/ml,15週100mIU/ml,24週cut-off値以下と設定した。

Four hundred and ninty one patients had been registered at our department for the management of postmolar pregnancy during the 8 years from 1983 to 1990. Serum samples were serially obtained from the patients who gave informed concent, and stored at -80℃. Human chorionic gonadotropin (hCG) level was assayed in the stored serum samples to study retrospectively the exact change of serum hCG levels in the postmolar courses. In addition, blood was sampled from 120 normal, non-pregnant women to set the cut-off value of serum hCG levels. The gained results are as follows: 1) The cut-off value of serum hCG levels was set at 5.0mIU/ml (95th percentile). 2) Of the 491 patients, 74 (15.1%) and 7 (1.4%) women developed invasive mole and choriocarcinoma, respectively. 3) Based on the serial change of serum hCG levels in the women who did not develop the sequelae, the upper limit of serum hCG levels was set at 10,000mIU/ml, 1,000mIU/ml and 100mIU/ml at the time point of 5,8 and 15 weeks after molar evacuation, respectiv

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