妊娠合并白血病27例临床分析

Clinical Analysis of 27 Cases of Leukemia with Pregnancy

目的探讨妊娠合并白血病患者的临床处理及妊娠结局。方法收集27例妊娠合并白血病患者的临床资料,回顾性分析其孕期特点、临床处理及妊娠结局进行分析。结果 (1)孕期临床处理及妊娠结局:孕前诊断9例,8例均足月分娩,1例在孕早期流产后继续化疗。孕早期诊断3例:2例流产后化疗,1例足月分娩。孕中期诊断11例:6例足月分娩,1例死亡,4例行引产后化疗。孕晚期诊断的共4例,均足月分娩。(2)母婴随访情况:失访5例,其余随访时间6~144月,母亲12例存活,10例死亡;27例中有19例活产,分娩后胎儿Apgar评分均>7分,随访至今仍健在,未发现胎儿畸形、发育不良、白血病等病史。结论白血病患者在病情缓解后慎重妊娠,可望得到较好的妊娠结局。白血病本身及治疗对于胎儿及孕妇存在一定风险,需要在有条件的综合性医院进行治疗及监管。

Objective To discuss the treatment and prognosis of leukemia complicating pregnancy. Methods The clinical data of 27 cases of leukemia complicating pregnancy were retrospectively analyzed. Data analyzed included pregnancy features,clinical treatment,and pregnancy outcomes. Results(1)The clinical treatment during pregnancy and pregnancy outcome:Of the nine cases diagnosed before pregnancy,eight were delivered in full-term and one continued chemotherapy after abortion in the early pregnancy term. Of the three cases diagnosed in the early pregnancy term,two received chemotherapy after abortion and one was delivered in full-term. Of the eleven cases diagnosed in the mid term,six were delivered in full-term,four received chemotherapy after induction of labor and one died. Four cases were diagnosed in the late pregnancy term,all of whom were delivered in full-term.(2)maternal and infant follow-up:five cases were lost to follow-up,the rest were followed up for 6~144months,twelve cases were alive and ten cases were dead. There were nineteen live births in twenty seven cases. The Apgar scores for the 19 cases were greater than seven points after delivery,they are all still alive. Among them we did not find any history of fetal malformation,dysphasia,leukemia. Conclusion Should leukemia patients in remission be careful about pregnancy,there may be a good pregnancy outcome. There is risk as result of leukemia and the treatment for the leukemia to the fetus and pregnant women,needing to be in a general hospital capable of the comprehensive treatment and supervision.