妊娠合并急性白血病三例并文献复习

Acute leukemia during pregnancy: a report of 3 cases and literature review

目的探讨妊娠合并急性白血病的诊断和治疗原则。方法报道3例妊娠合并急性白血病的典型病例,并以"妊娠"、"白血病"为检索词,在Pubmed、万方数据知识服务平台检索国内外相关文献,结合2014年国内外文献分析妊娠合并急性白血病的临床特点。结果 3例全部为妊娠期间诊断为急性白血病。其中1例为妊娠早期合并急性白血病,于局部麻醉下人工流产;2例为妊娠晚期合并急性白血病,1例于妊娠期行化学治疗后至孕36周早产一活婴,1例以期待疗法至孕35+4周获得活婴。2例产后均子宫复旧良好,产褥期无严重母体产科并发症如产后大出血、DIC、子宫切除、肝肾衰竭等。期待疗法患者因产后拒绝化学治疗,于剖宫产术后2个月死亡。2014年发表的妊娠与急性白血病的临床研究有7篇。国内外文献显示,在妊娠中晚期比在早期接受治疗胎儿的并发症更少,但延迟治疗可能影响母体的治疗,导致完全缓解率降低。结论妊娠期间合并急性白血病发生率较低,但处理棘手,需要多学科综合治疗,治疗时应根据患者所在妊娠阶段、意愿及白血病的状态等制定个体化诊疗方案。

Objective To investigate the diagnosis and treatment of acute leukemia during pregnan-cy.Methods Three typical cases of acute leukemia during pregnancy were reported.And “pregnancy”and“leukemia”（and corresponding Chinese terms）were used to retrieve related literature in PubMed and Wan-Fang database to analyze the clinical characteristics of patients with leukemia during pregnancy.Results Three pregnant subjects were diagnosed with leukemia during pregnancy.One patient complicated with acute leukemia during early pregnancy was subject to abortion under local anesthesia.The remaining 2 cases had acute leukemia during late pregnancy,one of whom delivered a premature infant after receiving chemotherapy and the other one delivered an infant at 35 ＋4 gestational weeks following expectant treatment.The uterus in all patients was well recovered.No severe maternal complications,such as postpartum hemorrhage,disseminated intravascular coagulation （DIC）,hysterectomy,renal and hepatic function failure,were observed during post-partum period.The patient receiving expectant therapy rejected chemotherapy and died at 2 months after cesar-ean section.A total of 7 clinical studies of acute leukemia during pregnancy were retrieved in 2014 and demon-strated that the infants had less complications if their parents received treatment during middle and late preg-nancy compared with those treated during early pregnancy.However,delayed treatment probably affected the clinical efficacy for pregnant women and thus reduced the overall remission rate.Conclusions The incidence of acute leukemia during pregnancy was relatively low,requiring multidisciplinary comprehensive treatment.In-dividualized diagnosis and treatment should be delivered according to the stage of pregnancy,patients’inten-tion and severity of leukemia.