妊娠合并颅内海绵状血管瘤15例临床分析  

Clinical Analysis of Pregnancy Combined with Cerebral Cavernous Malformations in 15 Cases

作　　者：张慧[1] 吕厚元 李柏乐 张心红[1] ZHANG Hui;LV Houyuan;LI Baile(Department of Obstetrics and Gynecology,Xuanwu Hospital,Capital Medical University,Beijing 10053,China)

机构地区：[1]首都医科大学宣武医院妇产科,北京100053

出　　处：《医学研究杂志》2024年第5期154-157,37,共5页Journal of Medical Research

基　　金：吴阶平医学基金会临床科研专项基金资助项目(320.6750.17203);首都医科大学本科生科研创新项目(XSKY2023221)。

摘　　要：目的分析妊娠合并颅内海绵状血管瘤(cerebral cavernous malformation,CCM)的临床特征及妊娠结局,探讨妊娠合并CCM患者的围生期管理。方法回顾性分析2015年8月~2022年8月首都医科大学宣武医院诊治的15例妊娠合并CCM患者的病理资料。结果15例患者共经历16次妊娠,均于孕前发现CCM。初始临床表现癫痫5例,突发头痛4例,因头痛发现脑出血1例,一过性晕厥1例,共济失调1例,无临床症状3例;以癫痫为临床表现的病例中,4例患者孕前手术或放疗后癫痫发作减轻或消失,1例孕前未治疗者孕期癫痫发作频繁,给予药物加量后未再发作;无孕期手术治疗者,无新发脑出血病例;孕足月阴道分娩3例,剖宫产11例,孕18周引产1例;产后突发癫痫持续状态1例,其余母儿健康。结论妊娠合并CCM需要多学科团队(multi-disciplinary team,MDT)共同管理,妊娠可能增加癫痫发作风险;孕前应至神经外科行风险评估,孕期适时调整抗癫痫药物,分娩后仍要严密监测。分娩方式的选择需要产科、神经科、麻醉科及母胎医学组成的MDT团队共同讨论评估后决定。Objective To analyze the clinical characteristics and outcome of pregnancy combine with cerebral cavernous malformation(CCM),and to investigate the management during perinatal period of pregnancy combine with CCM.Methods A total of 15 cases of pregnancy combine with CCM were admitted to Xuanwu Hospital,Capital Medical University from August 2015 to August 2022.A retrospective analysis was performed on the data.Results The 15 patients had a total of 16 pregnancies and CCM were found in pre-pregnancy examination.The initial manifestations were epilepsy in 5 cases,sudden headache in 4 cases,headache due to cerebral hemorrhage in 1 case,transient syncope in 1 case,ataxia in 1 case and no clinical symptoms in 3 cases.Among the clinical manifestations of epilepsy,4 patients were relieved or disappeared after treated by operation or radiotherapy before pregnancy,1 patient without treatment had frequent seizures during pregnancy and disappeared after increasing drug dosage.No new cases of operation and cerebral hemorrhage during pregnancy.3 cases had vaginal delivery and 11 cases selected cesarean section after 37 weeks of labor and 1 case required termination of pregnancy at the week of 18 weeks.1 patient suffered status epilepticus after postpartum,and the remaining cases were healthy.Conclusion Pregnancy combine with CCM needs multi-disciplinary team(MDT)management.Pregnancy may increase the risk of epilepsy.Risk assessment should be performed by neurosurgery department before pregnancy,and antiepileptic drugs should be adjusted during pregnancy,Close monitoring after delivery is also important.The mode of delivery is decided after discussion and evaluation by the MDT team composed of obstetrics,neurology,anesthesiology and maternal-fetal medicine.

关 键 词：妊娠 颅内海绵状血管瘤 脑出血 癫痫 多学科团队管理 

分 类 号：R651.12[医药卫生—外科学]