妊娠合并肝癌的临床分析  

Clinical analysis of pregnancy complicating hepatic carcinoma

作　　者：滕奔琦[1] 白小艺[1] 郝秀兰[1] 侯红瑛[1] 

机构地区：[1]中山大学附属第三医院妇产科,广州510630

出　　处：《中华产科急救电子杂志》2012年第2期34-37,共4页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：【摘要】目的分析妊娠合并肝癌患者的临床资料及生化指标特点，以提高临床诊断率。方法收集2008年7月至2012年6月在中山大学附属第三医院妇产科确诊的9例妊娠合并肝癌患者的临床资料，对其影像学资料、生化指标、治疗经过以及出院随访资料进行分析。结果9例妊娠合并肝癌患者，早期临床表现并不典型，肝功能仅显示轻～中度异常，2例在中孕期确诊肝癌，7例在晚孕期确诊。治疗方法包括肝动脉栓塞、介入治疗和肝脏肿物切除；孕妇结局不佳，有5例合并肝癌破裂出血，随访期间患者存活4例，死亡3例，失访2例；9例患者彩色多普勒超声的声像图均为肝硬变声像；生化指标显示，9例患者HBsAg均阳性，体内乙型肝炎病毒DNA不同程度复制；肝癌血清学标志物的甲胎蛋白升高显著，d．L一岩藻糖苷酶则无明显升高。结论妊娠合并肝癌早期诊断较困难，预后差，慢性乙型肝炎后肝硬变是肝细胞癌高危人群，重视高危人群的肝脏超声检查及血清甲胎蛋白的测定是提高诊断率的重要措施。Objective To studies the clinical feature and biomarkers of pregnancy complicating hepatic carcinoma and increase the clinical diagnose rate. Methods Clinical data of 9 pregnant women with liver carcinoma admitted into the obstetrics and gynecology department of the Third Affiliated Hospital of Sun Yat-sen University from July 2008 to June 2012 were retrospectively analyzed. Clinical data included radiology data, serological biomarkers, treatment and follow up observations. Results Among the 9 patients, clinical manifestations were not unique and the liver function did not appear serious injury at the beginning. Two women were diagnosed as liver carcinoma at the second trimester of pregnancy and 7 at late trimester of pregnancy. The treatments included hepatic artery embolization, interventional therapy and liver tumor resection. The outcomes of the pregnant women were not good. Five patients had spontaneous rupture and bleeding of liver carcinoma. During follow up observations, four patients were alive, three patients died and the other two lost. Color doppler ultrasound showed cirrhosis of the liver. Serological biomarkers showed hepatitis B surface antigen （HBsAg） was positive in the nine patients and hepatitis B virus DNA （ HBV DNA ） replicated in different levels. Alpha fetoprotein （ AFP ） was significantly associated with liver carcinoma during pregnancy, but it was not the same as alpha-L-fucosidase （AFU）. Conclusions It is hard to diagnose liver carcinoma in early trimester of pregnancy and the prognosis is bad. Pregnancy with cirrhosis, as high risk patients, should accept regular examination using ultrasound test in addition to AFP.

关 键 词：妊娠 高危 肝肿瘤 肝硬化 

分 类 号：R735.7[医药卫生—肿瘤] R714.2[医药卫生—临床医学]