妊娠合并肝细胞癌的临床特征分析  

Clinical features of hepatocellular carcinoma in pregnancy

作　　者：赵涵 陈铿[1] 应若素[1] 李平红 刘惠媛[1] ZHAO Han;CHEN Keng;YING Ruosu(Department of severe liver disease,Institute of Infectious Diseases,Guangzhou Eighth People′s Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院感染病中心重症肝病科,广州510060

出　　处：《临床肝胆病杂志》2018年第8期1693-1696,共4页Journal of Clinical Hepatology

基　　金：广州市科技计划项目(2010GN-E00221);广州市第八人民医院院内科研立项(2014BY002)

摘　　要：目的探讨妊娠合并肝细胞肝癌的临床特征、治疗和预后。方法选取2011年1月-2017年11月于广州市第八人民医院确诊的2例妊娠合并肝细胞癌的患者,及2010年-2017年中外医学文献中报道的23例妊娠合并肝细胞癌的患者,另选取2011年1月-2017年11月于广州市第八人民医院进行治疗的25例无妊娠育龄女性肝细胞癌患者的临床资料作为对照组进行回顾性分析。结果全部患者年龄18~45岁,大部分有乙型肝炎病史,肝功能正常或者轻到中度升高,临床表现以腹痛常见,治疗方法包括肝动脉栓塞、介入治疗、化疗和肝脏肿物切除。25例妊娠合并肝细胞癌患者预后不佳,17例患者死亡,在死亡的患者中可以查询到总生存期的患者有13例,生存期最长为2年,最短为1个月,中位生存期为2个月,16例患者靠剖宫产娩出健康胎儿。另25例无妊娠育龄女性肝细胞癌患者中有18例患者死亡,生存期最长为6年,最短为4个月,中位生存期为1年,6例患者在截稿日仍存活,1例患者失访。结论妊娠合并肝细胞癌的患者一经诊断已为中晚期,进展快,预后差,治疗多为手术及介入为主,早期发现可提高手术率及其他综合性治疗机会。Objective To investigate the clinical features,treatment,and prognosis of hepatocellular carcinoma（ HCC） in pregnancy.Methods A retrospective analysis was performed for the clinical data of two patients who were diagnosed with HCC in pregnancy from January 2011 to November 2017,23 patients with HCC in pregnancy reported in medical literature in China and foreign countries published from2010 to 2017,and 25 non-pregnant female patients of childbearing age with HCC（ control group） who were treated from January 2011 to November 2017. Results The patients＇ age ranged from 18 to 45 years,and most patients had a history of hepatitis B,with normal liver function or mild to moderate elevations. The most common clinical symptom was abdominal pain,and the therapies included hepatic artery embolization,interventional therapy,chemotherapy,and liver tumor resection. The 25 patients with HCC in pregnancy had poor prognosis,among whom 17 died,and among these 17 patients,13 had available information on overall survival time,which ranged from 1 month to 2 years,with a median survival time of 2 months; 16 patients gave birth to healthy infants by cesarean section. Among the 25 non-pregnant female patients of childbearing age with HCC,18 died,and the survival time ranged from 4 months to 6 years,with a median survival time of 1 year; 1 patient was lost to follow-up,and 6 patients were still alive before the deadline. Conclusion Most patients with HCC in pregnancy are found to have advanced HCC at the time of diagnosis. This disease has rapid progression and poor prognosis,and surgery and interventional therapy are major treatment regimens. Early identification can increase surgical rate and the opportunity for multimodality therapy.

关 键 词：妊娠 癌 肝细胞 肝炎 乙型 治疗学 预后 

分 类 号：R735.7[医药卫生—肿瘤]