妊娠期合并恶性肿瘤的临床分析

Clinical Analysis of Pregnancy Accompany With Malignant Tumor

目的探讨妊娠期合并恶性肿瘤的治疗及对母婴结局的影响。方法选择2006年1月至2011年12月,于本院产科分娩的妊娠期合并恶性肿瘤20例为研究对象。其中乳腺癌为6例(30.00%),宫颈癌为5例(25.00%),肝癌为3例(15.00%),卵巢癌为2例(10.00%),甲状腺癌为2例(10.00%),鼻咽癌为1例(5.00%),颅内恶性肿瘤为1例(5.00%)。妊娠期合并恶性肿瘤发生率为0.24%(20/8261)。回顾性分析患者的临床表现、诊断结果、孕期和产后治疗情况,分娩孕周,分娩方式,新生儿出生体重,生后1minApgar评分及有无畸形等,并电话随访患者的生存情况截至2012年4月(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并与受试对象签署临床研究知情同意书)。结果 20例患者中,放弃妊娠行引产术为6例(30.00%),继续妊娠的14例(60.00%)患者中,孕期接受化疗者为4例,孕期行肿瘤手术治疗者为4例;剖宫产为11例,阴道分娩为3例。新生儿分娩时胎龄为30+5～39孕周,新生儿出生体重为(1380～3200)g,无一例新生儿窒息和畸形发生。结论妊娠期合并恶性肿瘤以乳腺癌和宫颈癌最为常见。治疗应根据肿瘤分期、妊娠时间、孕妇意愿(是否继续妊娠)等因素综合考虑后,进行个体化治疗。中、晚孕期可相对安全地对部分患者实施手术治疗,并使用相对安全的化疗药物。

Objective To investigate the clinical effects of pregnancy accompany with malignant tumor and its impact on mother and fetus. Methods The clinical data of 20 pregnant women accompany with malignant tumor in SUN Yat-sen Memorial Hospital from 2006 to 2011 were analyzed retrospectively. Among them, the tumors associated with pregnancy were breast cancer （6/20, 30.00%）, cervical cancer （5/20, 25.00%）, liver cancer（3~20,]5.00~）, ovarian cancer （2/20, 10. 00~）, thyroid cancer （2/20, 10.00~）, nasopharyngeal carcinoma （1/20, 5.00%）, and malignant brain tumor（ 1/20, 5.00%）. The following items were analyzed retrospectively, clinical manifestations, diagnosis, pre- and post-parturition, gestational weeks, delivery methods, birth weight of neonate, Apgar score and abnormality. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of SUN Yat-sen Memorial Hospital, SUN Yat-sen University. Informed consent was obtained from all participates. Results Among 20 cases, six patients（30.00 ~ ） opted to therapeutic abortion, four patients （ 20. OO ~ ） received chemotherapy at the second or third trimester, four patients（20.00~） received surgery during pregnancy. Eleven cases（78.57~/0,i1/14） received cesarean section and 3（21.43% ,3/14） received vaginal delivery at 30＋^-39 gestation weeks. Neonatal birth weight was （1380-3200）g. There was no neonatal asphyxia and congenital malformation. Conclusions Surgery can be conducted safely during pregnancy. Some chemotherapy drug can be applied in the second and third trimester. The management of tumor associated with pregnancy mainly depends on tumor stage, gestational age and the patient＇s wishes.