妊娠合并神经胶质瘤的临床分析

Clinical Analysis of Glioma During Pregnancy

目的探讨并提高对妊娠合并神经胶质瘤的认识。方法回顾性分析2007年1月至2012年12月首都医科大学宣武医院经手术治疗后病理组织学检查证实的4例妊娠合并神经胶质瘤患者的临床资料,结合相关文献复习其临床表现、治疗及转归。结果本组4例患者均以头痛、恶心等颅内压增高表现为起始症状,2例伴视物模糊及肢体肌力下降,2例有癫痫发作。4例均经头颅MRI检查初步诊断。本组所有病例均给予甘露醇静脉滴注降低颅内压,同时进行预防感染等治疗,2例分别以丙戊酸钠、奥卡西平抗癫痫治疗。2例全身麻醉下行剖宫产术+开颅手术,1例在开颅手术后2周行剖宫产术,1例开颅手术后继续妊娠。本组4例患者中,3例剖宫产患者分娩3例新生儿均存活。1例于产后4个月开始化疗。1例继续妊娠患者,术后并发硬膜外血种。对本组4例患者产后均随访6个月,3例患者存活,1例死亡。结论妊娠合并神经胶质瘤的临床表现无特殊性,易与其他疾病相混淆。MRI检查在孕期是安全的,一般不需要强化。该病孕妇分娩方式以剖宫产为宜。该病患者预后取决于肿瘤的位置和组织生物学特性。

Objective To investigate the awareness of pregnant women with glioma. Methods Retrospective analysis clinical data of pregnant women with glioma confirmed by pathology from January 2007 to December,2012 in Xuanwu Hospital,Capital Medical University.Literature review of its clinical manifestations, treatments and outcomes. Results In this study, 4 cases of pregnant women had high intracranial pressure performance so as to headache and nausea symptom onset, 2 cases with blurred vision, followed by a decline in limb muscle strength,2 cases have seizures. All of 4 cases initial diagnosed by brain MRI. All cases had been given mannitol intravenously to reduce intracranial pressure and anti-infection treatment,2 cases with sodium valproate, oxcarbazepine antiepileptic therapy. Among them, 2 cases operated with cesarean section and craniotomy under general anesthesia,1 case operated with cesarean section followed by craniotomy two weeks later,1 case continued the pregnancy after craniotomy, childbirth 3 neonatus with survival. After deliver 4 months later 1 case of postpartum with chemotherapy. Postpartum follow up of 6 months：3 cases survived and 1 died. Conclusions The clinical manifestations of pregnancy with glioma is non-specificity,easy to be confused with other diseases. MRI is safe during pregnancy, generally does not need enhancement. It＇s better for pregnant women with glioma to choose cesarean section. The prognosis of glioma depends on the tumor＇s histology、biological characteristics and location.