妊娠合并颅内肿瘤22例临床分析

Intracranial tumors in pregnancy:a clinical study of 22 cases

目的：探讨妊娠合并颅内肿瘤的临床处理。方法对本院1989~2012年收治的妊娠合并颅内肿瘤患者22例进行回顾性分析。结果22例患者中神经胶质瘤11例,脑膜瘤5例,血管网状细胞瘤2例,听神经瘤1例,成熟畸胎瘤1例,转移性肿瘤2例；经产妇11例,初产妇11例；早期妊娠4例,中期妊娠9例,晚期妊娠9例。22例患者中19例患者围产期接受开颅手术。早期妊娠4例患者中1例自然流产,3例人工流产；中期妊娠9例患者中1例因病情危重急行开颅手术无产科处理,中期引产6例,2例继续妊娠至晚期行剖宫产分娩；晚期妊娠9例患者中8例剖宫产分娩,1例自然分娩。11例新生儿早产儿5例,足月产儿6例；1例新生儿重度窒息生后5天死亡,其余10例新生儿均存活。结论妊娠本身并不增加罹患颅内肿瘤的风险,但妊娠可加速已存在的颅内肿瘤的生长,加重临床表现。妊娠合并颅内肿瘤患者的处理需产科和神经外科医生密切协作、共同管理,应充分评估孕母的肿瘤因素及孕周和胎儿成熟度以及妊娠意愿,权衡利弊,适时终止妊娠并进行神经外科手术治疗,在一定条件下仍可能取得良好的妊娠结局。

Objective To explore the management of intracranial tumors in pregnant women. Method We retrospec-tively analysised 22 pregnant women with intracranial tumors treated at Xuanwu hospital between 1989 and 2012.Result In 22 patients, there are 11 cases of glioma, 5 cases of meningioma, 2 cases of hemangioblastoma, 1 case of acoustic neuroma, 1 case of mature teratoma and 2 cases of metastatic tumor. Among them,11 cases of multipara, 11 cases of primipara. There are 4 cases of early pregnancy; 9 cases of mid pregnancy, 9 cases of late pregnancy. A total of 19 patients underwent neurosurgery operation. In 4 cases of early pregnancy, 1 case spontaneous abortion, 3 cases were performed abortion. In 9 cases of mid-term gestation, 1 case received emergency craniotomy operation immediately after admission without obstetric treatment because of critical condition,6 cases of mid-induced labor,2 cases continue the pregnancy to the third trimester and underwent cesarean section delivery. 8 cases of late pregnan-cy patients underwent cesarean delivery and the other 1 case of natural childbirth. In 11 neonatal,there are 5 prema-ture infants, 6 full-term infants. Among them,1 neonatal died five days later due to severe asphyxia, the rest 10 newborn were alive. Conclusion The incidence of intracranial tumors does not seem to be increased during pregnan-cy. However,pregnancy accelerates the growth of existing brain tumors,aggravates clinical manifestations. Manage-ment of intracranial tumors during pregnancy is challenging, obstetrician and neurosurgeons need close cooperation, joint management,we should fully evaluate tumor factors of motherhood and gestational age, fetal maturity and preg-nancy will, weigh the pros and cons, and timely termination of pregnancy and nerve surgical treatment. A good out-come of pregnancy might be get under proper management.