妊娠合并肝癌的临床分析_滕奔琦.pdf

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1、·112·中华产科急救电子杂志2012年11月第1卷第2期ChinJObstetEmerg(ElectronicEdition)，November2012，Vol．1，No．2·论著·妊娠合并肝癌的临床分析滕奔琦白小艺郝秀兰侯红瑛【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

2、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，α-L-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

3、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。【关键词】妊娠，高危;肝肿瘤;肝硬化ClinicalanalysisofpregnancycomplicatinghepaticcarcinomaTENGBen-qi，BAIXiao-yi，HAOXiu-lan，HOUHong-ying．DepartmentofObstetricsandGynecology，theThirdAffiliatedHospitalofSunYat-senUniversity，Guangzhou510630，Chin

4、aCorrespondingauthor:HOUHong-ying，Email:gdgzhhhy@163．com【Abstract】ObjectiveTostudiestheclinicalfeatureandbiomarkersofpregnancycomplicatinghepaticcarcinomaandincreasetheclinicaldiagnoserate．MethodsClinicaldataof9pregnantwomenwithlivercarcinomaadmitted

5、intotheobstetricsandgynecologydepartmentoftheThirdAffiliatedHospitalofSunYat-senUniversityfromJuly2008toJune2012wereretrospectivelyanalyzed．Clinicaldataincludedradiologydata，serologicalbiomarkers，treatmentandfollowupobservations．ＲesultsAmongthe9patie

6、nts，clinicalmanifestationswerenotuniqueandtheliverfunctiondidnotappearseriousinjuryatthebeginning．Twowomenwerediagnosedaslivercarcinomaatthesecondtrimesterofpregnancyand7atlatetrimesterofpregnancy．Thetreatmentsincludedhepaticarteryembolization，interv

7、entionaltherapyandlivertumorresection．Theoutcomesofthepregnantwomenwerenotgood．Fivepatientshadspontaneousruptureandbleedingoflivercarcinoma．Duringfollowupobservations，fourpatientswerealive，threepatientsdiedandtheothertwolost．Colordopplerultrasoundsho

8、wedcirrhosisoftheliver．SerologicalbiomarkersshowedhepatitisBsurfaceantigen(HBsAg)waspositiveintheninepatientsandhepatitisBvirusDNA(HBVDNA)replicatedindifferentlevels．Alphafetoprotein(AFP)wassignificantlyassociatedwithlivercarcinomaduringpregnancy，but