Partial hydatidiform mole

　　The true cause of hydatid mole is unknown. Case-control studies have found that the occurrence of hydatid mole is related to nutritional status, socioeconomic status, and age. Age is a significant risk factor in etiology. The incidence of hydatid mole in women over 40 is 10 times higher than that in young women. Women under 20 are also at high risk for complete hydatid mole, as they are more prone to fertilization defects. The age of the pregnant woman is not related to partial hydatid mole.

　　Combined with cytogenetic and pathological studies, it has been proven that the two types of hydatid moles have their own genetic characteristics. The karyotype of partial hydatid mole is often trisomy, with 80% being 69,XXY, and the rest being 69,XXX or 69,XYY. This is due to the fertilization of a normal ovum with two sperm, bringing an extra set of paternal chromosome components. It can also be caused by the combination of a normal haploid ovum (or sperm) with a diploid zygote that failed in meiosis.

　　1. Massive hemorrhage If hydatid mole is not diagnosed and treated in a timely manner, it can cause recurrent bleeding, uterine hemorrhage, leading to anemia. It can also cause massive hemorrhage during spontaneous expulsion, and on the basis of anemia, hemorrhagic shock can occur, even leading to death. Therefore, hydatid mole should be treated as an emergency, as a short delay can cause more bleeding and harm the patient.

　　2. Incomplete abortion of hydatid mole After spontaneous abortion or aspiration abortion, there may be residual hydatid moles. For patients with hydatid mole who have a spontaneous abortion not long before admission and can undergo evacuation of the uterus, evacuation should be performed immediately. For those with a longer duration of retention and signs of infection, antibiotics should be administered and the uterus should be evacuated a few days later.

　　3. Hydatid mole embolism Hydatid mole can be transferred or migrate to other parts of the body through blood circulation, the most common being the lungs and vagina, and it can form bleeding foci locally. Small clots or those not thoroughly examined may regress spontaneously. Pei Liang et al. reported a case where the use of oxytocin for induction of labor caused widespread lung metastasis of hydatid mole, leading to pulmonary arteriosclerosis syndrome and death due to pulmonary edema and heart failure. Hydatid mole embolism can differ from metastasis of malignant tumors and can be resolved by autoimmune suppression. Lin Qiaozi and Su Yingkuan have also reported such cases. Currently, chemotherapy is still the preferred treatment after diagnosis.

　　Four, malignant transformation It can become invasive hydatidiform mole or choriocarcinoma, with a malignant transformation rate of about 10% to 20%.

　　Five, torsion of the pedicle of ovarian luteinizing cyst It often occurs after the hydatidiform mole is excreted and torsion of the pedicle occurs. Immediate surgery should be performed to remove the torsed uterine appendages.

　　One, amenorrhea Since hydatidiform mole occurs in the trophoblast of the embryo, most patients have amenorrhea for 2-3 months or even longer.

　　Two, vaginal bleeding A serious symptom, it is the manifestation of spontaneous abortion of hydatidiform mole. It usually starts within 2-3 months of amenorrhea, and is mostly intermittent, small bleeding, but there may be repeated large bleeding. If checked carefully, vesicular-like objects may be found in the bleeding. Vaginal bleeding is obviously from the uterus, part of which is discharged from the vagina, and part is accumulated in the uterus; it may also be completely accumulated in the uterus for a while, thus prolonging the amenorrhea period.

　　Three, uterine enlargement The uterus of most patients is larger than that of the corresponding menstrual pregnancy uterus. Many patients come to the clinic because they feel a mass (enlarged uterus or luteinizing cyst) in the lower abdomen. However, there are also a few cases where the uterus and menstrual period are very similar or even smaller than the menstrual period. There may be two situations: ① The villous vesicles degenerate into a萎缩状, stop developing, and form a missed abortion of hydatidiform mole; ② Part of the vesicular placental masses have been expelled, causing the uterine body to shrink and form an incomplete abortion of hydatidiform mole.

　　Four, abdominal pain Due to the rapid growth of the uterus causing pain, or intrauterine bleeding causing uterine contraction and pain, which can be mild or severe.

　　Five, symptoms of pregnancy-induced hypertension About half of the patients may experience severe vomiting after menopause, and hypertension, edema, and proteinuria may occur later.

　　Six, no accessible fetus Around 8 weeks before and after amenorrhea, B-ultrasound monitoring shows no gestational sac, fetal heart, or fetus, and there is no sense of fetal movement, even up to 18 weeks, and the fetal heart sound cannot be heard. B-ultrasound scanning shows snowflake-like images without fetal images.

　　Seven, ovarian luteinizing cyst Ovarian luteinizing cysts often occur in some patients, which can be found through bimanual examination or more easily through ultrasound.

　　Eight, hemoptysis Some patients may have hemoptysis or sputum with blood, and doctors should actively inquire whether they have this symptom.

　　Nine, anemia and infection Recurrent bleeding without timely treatment will inevitably lead to anemia and related symptoms. Some individuals may even die due to bleeding. Recurrent bleeding is prone to infection, especially if vaginal manipulation is unclean or sexual intercourse occurs during bleeding, which may promote the occurrence of infection. Infection can be localized to the uterus and its appendages, and may lead to sepsis.

　　All patients with hydatidiform mole should be advised to follow up regularly, preferably maintain long-term contact with the hospital, and most importantly, to have regular reviews within 2 years. The purpose is to detect malignant transformation early, but sometimes there may also be residual vesicular placental masses. Patients should be advised to take effective contraception measures at least within 2 years, and they should have a review once a month in the first six months. If irregular vaginal bleeding, hemoptysis, headache, or other discomfort occurs, they should go to the hospital immediately.

　　During follow-up examination, in addition to asking about the normality of menstruation, attention should also be paid to the presence of the above symptoms. During the examination, attention should be paid to whether the uterus is well restored, and whether there are purple-blue nodules in the vagina and vulva. Chest X-ray (it is best to take a chest X-ray) may show shadows.

　　The pregnancy test is very important during follow-up. After the complete removal of hydatidiform mole, more than 60% of patients have a negative pregnancy test within 30 days. If the test remains positive after more than 40 days, it should be highly suspected of malignant transformation or residual vesicular mass.

　　If the pregnancy test becomes negative and then positive again during follow-up, if it is not pregnancy, it should be highly suspected of malignant transformation. If the original urine is positive, the dilution test has turned negative, and the dilution test turns positive again during follow-up, especially if the dilution degree increases, it should also be highly suspected of malignant transformation.

　　1. B-ultrasound:Abdominal scanning may show varying sizes of dark areas in the uterus, which are caused by blood clots in the uterine cavity. It can also detect the fetus, that is, in addition to the snowflake-like images, there may also be fetal and/or placental images. B-ultrasound diagnosis is non-invasive, with a high rate of diagnosis, and is a powerful measure for confirming hydatidiform mole.

　　2. hCG determination:The accurate quantitative test of hCG is an important test for diagnosing and following up hydatidiform mole. The level of hCG is low at the beginning of normal pregnancy, reaches a peak at 8-10 weeks of pregnancy, and then gradually decreases. After 100 days of gestation, hCG levels significantly decrease. In twin (multiple) pregnancies, the hCG level is also higher than that in single pregnancies. In hydatidiform mole, the hCG level is much higher than the normal value and remains at a high level. In normal non-pregnant women, the serum hCG level is less than 75 mIU/ml, and β-hCG is less than 20 mIU/ml. The median peak value of serum hCG in normal pregnant women is below 100,000 mIU/ml, and the highest value reaches 210,000 mIU/ml. In hydatidiform mole patients, the serum hCG value is much higher than 200,000 mIU/ml. Therefore, combined with clinical and B-ultrasound findings, a single high hCG value can confirm the diagnosis of hydatidiform mole. If periodic follow-up quantitative tests of hCG are performed, and the hCG level remains high after 14 weeks of pregnancy, the diagnosis can be more clear.

　　If the hydatidiform mole is excluded for more than 8 weeks, and the uterus is confirmed to be free of residual hydatidiform mole after careful curettage, and there is no luteinized cyst, the serum hCG level remains above 1000 mIU/ml or even rises, and subsequent coloration confirms malignant transformation, if the hCG level is below 1000 mIU/ml and there is a luteinized cyst, it is still necessary to carefully check for the presence of metastatic lesions, or it may be due to luteinized ovarian cysts, and close follow-up should be maintained. If the luteinized cysts regress and the hCG level decreases, the patient should continue to be followed up as a benign hydatidiform mole.

　　The common method for testing the abnormality of grapes is to perform a pregnancy test, but if the patient with hydatidiform mole does not use contraception after surgery and becomes pregnant, it is difficult to determine whether the patient has malignant transformation of hydatidiform mole or pregnancy. Hydatidiform mole is a disease caused by abnormal fertilized egg, with no fetus in the uterine cavity, only multiple water blisters shaped like grapes, hence the name 'hydatidiform mole'. According to statistics, about 10-15% of patients with hydatidiform mole have malignant transformation.

　　Therefore, patients with hydatidiform mole should abstain from pregnancy for at least one year before becoming pregnant. The preferred method is the condom, followed by external contraceptives. It is not advisable to take oral contraceptives or to have an intrauterine device inserted, as oral contraceptives can delay the regression of the residual trophoblastic cells of hydatidiform mole, and the insertion of an IUD can stimulate the endometrium, all of which may indirectly promote the occurrence of malignancy.

　　In terms of diet, it is recommended to consume the following plan:

　　Stewed sea cucumber with Chinese yam and American ginseng

　　Prescription and usage: 96 grams of dried sea cucumber, 10 grams of American ginseng (separately packaged, only cooked for 15 minutes), 250 grams of pork backbone, 65 grams of Chinese yam, a moderate amount of salt and peanut oil. First, cut the dried sea cucumber into small pieces, and place them with the chopped pork backbone in a large炖盅, add Chinese yam and an appropriate amount of water, bring to a boil and then simmer over low heat for 1 hour, then add the slices of American ginseng, wolfberry, vegetable oil, and salt, and simmer for another 15 minutes. Drink the soup in portions and eat the sea cucumber.

　　Function: prevent and fight cancer, replenish Qi and blood.

　　Sea cucumber is warm in nature, rich in protein, calcium, and iron. The mucopolysaccharides it contains can effectively improve the body's immune function, inhibit the growth of tumor cells, and prevent their metastasis. The海参saponin it contains also has anti-cancer effects; American ginseng is slightly bitter and sweet, cool in nature, with the effects of replenishing Qi and nourishing Yin, clearing fire and generating saliva, especially suitable for those with both Qi and Yin deficiency who experience fatigue, thirst, dry tongue, and dizziness after radiotherapy or chemotherapy; Chinese yam is sweet and neutral in nature, tonifying Qi and nourishing Yin, benefiting the spleen and kidneys; wolfberry is sweet and neutral in nature, nourishing blood and enriching essence, improving eyesight and protecting the liver, which can alleviate the damage to the liver caused by chemotherapy drugs; accompanied by pork backbone for replenishing骨髓, it has the effects of preventing and fighting cancer, and replenishing Qi and blood.

　　This recipe can also be used for common people to replenish their health, and for women to nourish themselves after their menstrual period.

　　Stir-fried eggplant and enoki mushrooms with goose blood

　　Prescription and usage: 125 grams of eggplant (cleaned, with skin, cut into pieces), 150 grams of enoki mushrooms (cleaned, cut into sections), 96 grams of goose blood. First, stir-fry the eggplant and enoki mushrooms with peanut oil and a moderate amount of salt over low heat until they are 70-80% cooked, then add the goose blood and quickly stir-fry, serve with side dishes. Take 1-2 doses daily, and can be used continuously for 7-10 days, or alternated with other cancer-preventing and cancer-fighting food therapy.

　　Function: nourish blood, prevent and fight cancer.

　　Eggplant is sweet and cool in nature, rich in vitamins A, C, and E. The solanine it contains can inhibit the formation of digestive tract tumors and promote bowel movements, having the effects of preventing and fighting cancer; enoki mushrooms are sweet and cool, with a high protein content.

　　In the treatment of this disease, relying solely on traditional Chinese medicine and herbs currently has a poor effect, and it is difficult to quickly expel the pathogen. It is advisable to primarily use modern medical treatment methods, through cleaning the uterine cavity and quickly removing the focus of the disease, in order to effectively control the disease. On this basis, combined with traditional Chinese medicine and herbs for辨证 treatment, it can both reinforce the body's resistance and expel the pathogen, often leading to satisfactory therapeutic effects. The treatment of this disease should be based on the fundamental principle of adjusting the Yin and Yang balance of the internal organs, taking into account both reinforcing the body's resistance and expelling the pathogen. For those with Yang deficiency and blood stasis, the focus is on warming the kidneys and transforming Yang, promoting blood circulation and removing blood stasis; for those with damp-heat stasis, it is necessary to clear heat and eliminate dampness, detoxify and resolve stasis, and pay attention to regulating Qi and blood. The specific therapy should mainly be in the form of oral decoctions or pills.

　　1. Differentiation and Selection of Prescription

　　1. Yang deficiency and blood stasis

　　Treatment Method: Warming the kidneys and supporting Yang, promoting blood circulation and removing blood stasis.

　　Prescription: Modified Shaofu Xuefu Decoction. Angelica sinensis 15g,芍药 15g, Chuanxiong 10g, Foeniculum vulgare 10g, Cinnamon 10g, Pycnogenol 15g, Achyranthes 15g, Leonurus 30g, Hedyotis diffusa 30g, Carthamus 15g. For those with severe blood stasis, add Trapa 15g, Curcuma 15g; for those with severe nausea and vomiting, add Zingiberis Rhizoma 15g, Pinellia ternata 15g; for those with both Qi and blood deficiency, add Codonopsis 20g, Astragalus 25g, Atractylodes 15g; for those with abdominal pain, add芍药 20g.

　　2. Blood stasis and heat mutually binding

　　Treatment Method: Clear heat and eliminate dampness, detoxify and remove blood stasis.

　　Prescription: Modified Ge Gen Bai Jie Decoction. Dandelion 30g, Patrinia 20g, Coptis 15g, Hedyotis diffusa 30g, Carthamus 15g, Spatholobus suberectus 30g, Moutan bark 15g, Salvia miltiorrhiza 15g, Poria 15g. For those with low fever and chest oppression, add Scutellaria baicalensis 15g, Bupleurum 10g; for those with severe nausea and vomiting, add Zingiberis Rhizoma 15g, Pinellia ternata 15g; for those with loose stools and general weakness, add Codonopsis 15g, Atractylodes 20g, Dioscorea 20g.

　　2. Other Therapies

　　1. Dahuang Zhechong Pill:Has the effects of removing blood stasis and promoting the production of new blood, and is mainly used for treating five types of exhaustion, emaciation, abdominal distension and pain, dry blood within the body, etc. It can be used to treat hydatidiform mole. Take one pill each time, three times a day, by mouth.

　　2. Guizhi茯苓丸:Has the effects of promoting blood circulation and removing blood stasis, and is mainly used for treating women with chronic mass in the lower abdomen, amenorrheic abdominal pain, etc. It can be used to treat hydatidiform mole. Take one pill each time, three times a day, by mouth.

　　3. Acupuncture: Body Acupuncture:Direct needle insertion 1-1.2 cun at Quchi point, direct needle insertion from inside to outside at Sanyinjiao point 0.5-1.0 cun. Once a day.