妊娠合并脑神经胶质细胞瘤的临床处理

Management of gliomas during pregnancy

目的 探讨妊娠合并脑神经胶质细胞瘤（简称脑胶质瘤）的临床处理. 方法 回顾性分析首都医科大学宣武医院1989年1月至2012年12月收治的11例妊娠合并脑胶质瘤患者的临床资料. 结果 11例患者均于妊娠期首次诊断为脑胶质瘤,其中妊娠早期诊断2例,妊娠中期诊断4例,妊娠晚期诊断5例.主要有头晕、头痛、恶心呕吐等颅内高压的表现伴癫痫及视物不清、听力减退、言语障碍等其他神经功能障碍的表现.11例患者中1例未行产科处理,5例行剖宫产,3例中期引产,1例人工流产,1例自然流产.共10例患者行开颅手术,术后病理为低级别胶质瘤4例,高级别胶质瘤6例.其中3例患者在接受开颅手术前终止妊娠,4例患者剖宫产后即行开颅手术,2例在开颅手术后终止妊娠,1例因病情危重入院后急诊行开颅手术,未行产科处理.共分娩新生儿5例,外观正常无畸形,其中4例存活,1例因重度窒息死亡.10例行开颅手术患者中,1例术后持续昏迷50 d后死亡,1例失访,6例行放疗＋化疗,1例行单纯化疗,1例未行放化疗.11例患者中1例未行开颅手术者剖宫产术后失访,其余10例中1例低级别胶质瘤患者术后50 d死亡,1例开颅手术后失访;8例患者术后随访4个月～3年,其中4例存活,4例高级别脑胶质瘤患者术后1年内死亡. 结论 妊娠合并脑胶质瘤患者的总体预后不良,应充分评估孕母的肿瘤情况、孕周、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.

Objective To explore the management of gliomas in pregnant women.Methods We retrospectively analyzed the clinical data in 11 pregnant women with gliomas treated at Xuanwu Hospital of Capital Medical University between January 1989 and December 2012.Results All the patients were first diagnosed with gliomas during pregnancy,including two cases during early pregnancy,four cases during midpregnancy,and five cases during late pregnancy.The main clinical manifestations were dizziness,headache,nausea and vomiting due to intracranial hypertension,accompanied by epilepsy and blurred vision,hearing and speech disorder and other neurological dysfunctions.Among the 11 patients,one received no obstetric treatment,five underwent cesarean section,three had metaphase induced labor,one had induced abortion,and one had spontaneous abortion.Five neonates appeared normal without malformation：four survived,and one with severe asphyxia died.Ten patients underwent neurosurgery,four of them were diagnosed with low-grade gliomas and six were diagnosed with high-grade glioma by pathology.Seven patients received craniotomy after termination of pregnancy,two underwent craniotomy before termination of pregnancy,and one received emergency craniotomy immediately after admission without obstetric treatment because of her critical conditions.Of the ten patients treated with craniotomy,one died after a coma for 50 days,one was lost to follow-up,six received radiotherapy plus chemotherapy,one received chemotherapy alone,and one received neither radiotherapy nor chemotherapy.Among the 11 patients,one patient who underwent cesarean section without craniotomy was lost to follow-up,one patient with low-grade glioma died 50 days after operation,one treated with craniotomy was lost to follow-up,and eight were followed up for four months to three years,among which four survived and four with high-grade glioma died within one year after operation.Conclusion The overall prognosis of glioma patients during pregnancy is poor.It is important to take into account the tumor status of the pregnant women,gestational age,fetal maturity and patient＇s desire for tocolysis,and weigh the pros and cons,and timely terminate pregnancy and perform neurosurgery.