妊娠合并肝细胞肝癌九例临床分析

Hepatocellular carcinoma in pregnancy : report of 9 cases

目的探讨妊娠合并肝细胞肝癌（肝癌）的临床特点、诊治和预后。方法回顾性分析2003年1月至2013年1月在中山大学附属第一医院妇产科接受诊治的9例妊娠合并肝癌患者临床资料。患者年龄18—37岁，中位年龄28岁，发现肝癌时孕周为18—37周，分娩孕周为18^＋5-38周，平均分娩孕周为33^＋1周。8例孕前有乙型病毒性肝炎病史。5例患者表现为上腹部或右上腹部持续性隐痛，1例下腹隐痛，1例恶心伴呕吐，1例腹胀伴恶心。甲胎蛋白水平106—58433μg／L；肝癌直径7-21cm。完善检查后行全院会诊，妇产科、肝胆外科、麻醉科等科室共同制定治疗计划。所有患者均签署知情同意书，符合医学伦理学规定。8例患者行剖宫产分娩，1例予以引产。2例患者剖宫产后1—2周行肝局部切除术，其中1例患者术后化学药物治疗（化疗）3个疗程，另1例患者术后未行化疗；1例患者剖宫产后进行单纯化疗3个疗程；其余6例放弃治疗。结果8例患者剖宫产均娩出健康婴儿。2例肝局部切除术患者术后至投稿日存活，已分别存活1年和4个月。1例单纯化疗患者，产后6个月因肝癌全身多发转移死亡；其余6例患者放弃肝癌治疗，产后3个月内死于肝癌破裂出血。结论妊娠合并肝癌患者缺乏特异性临床症状，确诊时多发展为中、晚期，治疗以手术及化疗为主，预后极差。早期发现、及时治疗有利于改善患者预后。

Objective To discuss the clinical characteristics, diagnosis, treatment and prognosis of patients with hepatocellular carcinoma （HCC） in pregnancy. Methods Clinical data of 9 patients with HCC in pregnancy in Department of Obstetrics and Gynecology of the First Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2013 were analyzed retrospectively. The patients＇ age was 18-37 years old with the median age of 28 years old. The patients were diagnosed as HCC at 18-37 gestational weeks, and they delivered at 18.5 -38 gestational weeks with an average of 33^1 weeks. Eight cases had a history of hepatitis B before pregnancy. Five cases suffered persistent upper or right upper abdominal dull pain, 1 case lower abdominal dull pain, 1 case nausea and vomiting, and 1 cases nausea and bloating. The level of alpha-fetoprotein （AFP） was 106-58 433 μg/L and the diameter of liver tumor was 7-21 cm. Hospital-wide consultation was hold after various examinations had been completed. The treatment plan was jointly developed by Department of Obstetrics and Gynecology, Hepatobiliary Surgery and Anesthesiology. The informed consents of all patients were obtained and the ethical committee approval was received. Caesarean section was performed in 8 patients and induced labour in 1 case. Two cases underwent segmental hepatectomy 1-2 weeks after caesarean section, of which 1 case received 3 periods of chemotherapy following the operation, while the other one received no chemotherapy. One case only received 3 periods of chemotherapy after caesarean section. And the other 6 cases abandoned treatment. Results Eight cases delivered healthy babies by cesarean section. Two cases who underwent segmental hepatectomy had survived for 1 year and 4 months respectively till the paper submission day. The case who received single chemotherapy died of systemic multiple metastasis of HCC within 6 months after delivery. The other 6 cases who abandoned treatment died of hemorrhage of HCC within 3 months after delivery. Conclusions Patients with HCC in pregnancy are lack of specific clinical manifestations, and most are diagnosed at the middle or advanced stage. The treatments are mainly surgery and chemotherapy and the prognosis is poor. Early detection and timely treatment can help to improve the prognosis.