宫颈大细胞神经内分泌癌伴抗利尿激素分泌异常综合征一例  

Large Cell Neuroendocrine Carcinoma of Cervix Complicated with Syndrome of Inappropriate Secretion of Antidiuretic Hormone:A Case Report

作　　者：赵雅琴 吴珍珍[1,2] 郑长才 孙健豪[2] 刘青 ZHAO Ya-qin;WU Zhen-zhen;ZHENG Chang-cai;SUN Jian-hao;LIU Qing(Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China;First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省妇幼保健院,兰州730050 [2]甘肃中医药大学第一临床医学院

出　　处：《国际妇产科学杂志》2024年第1期70-73,共4页Journal of International Obstetrics and Gynecology

摘　　要：宫颈大细胞神经内分泌癌(large cell neuroendocrine carcinoma,LCNEC)是一种具有内分泌功能的恶性肿瘤,是抗利尿激素分泌异常综合征(syndrome of inappropriate secretion of antidiuretic hormone,SIADH)的病因之一。报告1例妊娠合并宫颈LCNEC患者,入院时存在轻度低钠血症,剖宫产终止妊娠后行化疗,化疗过程中出现了重度低钠血症伴抽搐、意识不清,诊断为SIADH。给予镇静镇痛、补钠、补钾、降颅压、纠正酸碱失衡等抢救措施后,患者血Na+水平恢复正常,随后行3个周期顺铂+依托泊苷方案化疗以及同步放化疗。最终患者肿瘤复发,因Ⅳ度骨髓抑制、体能状况差,无法耐受抗肿瘤治疗而终止治疗后死亡。SIADH早期识别与诊断困难,诊治不当可导致认知障碍、癫痫、昏迷和渗透性脱髓鞘综合征等,影响患者预后。Large cell neuroendocrine carcinoma(LCNEC)of cervix is a kind of cervical malignant tumor with endocrine function,which is one of the causes of syndrome of inappropriate secretion of antidiuretic hormone(SIADH).A case of pregnancy complicated with LCNEC of cervix was reported.Mild hyponatremia was found upon hospitalization.After termination of pregnancy by cesarean section,the patient underwent neoadjuvant chemotherapy.During the chemotherapy course,the patient developed severe hyponatremia accompanied by convulsions and unconsciousness,which was diagnosed as SIADH.After implementing rescue measures such as sedation,analgesia,sodium supplementation,potassium supplementation,cranial pressure reduction,and correction of acid-base imbalance,the patient′s plasma sodium concentration returned to within normal range.Subsequently,the patient underwent 3 cycles of cisplatin combined with etoposide chemotherapy and concurrent chemoradiotherapy.Eventually,the tumor recurred,and the patient unable to tolerate anti-tumor therapy due to fourth-degree bone marrow suppression and poor physical condition,which led to eventual demise.Early recognition and diagnosis of SIADH are difficult,and improper diagnosis and treatment can lead to cognitive impairment,epilepsy,coma,osmotic demyelinating syndrome,etc.,affecting the prognosis of patients.

关 键 词：宫颈肿瘤 癌 神经内分泌 癌 大细胞 低钠血症 ADH分泌不当综合征 

分 类 号：R737.33[医药卫生—肿瘤]