目的 探讨妊娠合并白血病患者的母儿结局. 方法 选择1980年6月1日至201 1年7月31日北京大学人民医院产科收治的进入围产期的23例妊娠合并白血病患者,包括妊娠前诊断的白血病9例(4例急性髓细胞白血病,5例慢性髓细胞白血病)和妊娠期首次诊断的白血病患者14例,其中急性白血病8例(急性髓细胞白血病7例,急性淋巴细胞白血病1例),慢性髓细胞白血病(慢性期)6例纳入研究,采用回顾性方法对其妊娠期临床处理、妊娠结局进行分析,并对母儿情况进行随访. 结果 (1)妊娠期临床处理:妊娠前诊断的4例急性髓细胞白血病患者中2例妊娠前已停化疗药物≥5年,另2例病情完全缓解,妊娠期病情均无复发,无特殊处理;5例妊娠前诊断的慢性髓细胞白血病患者血常规监测异常,但妊娠期疾病仍一直处于慢性期,妊娠期1例使用羟基脲治疗,1例使用伊马替尼,余3例无任何治疗.14例妊娠期首次诊断的白血病患者中,血常规检查均有白细胞异常,其中9例同时伴有贫血和血小板计数异常,4例伴单一贫血或血小板计数异常.8例急性白血病患者中除1例因妊娠40周和1例发生死胎未进行化疗外,6例进行了化疗.6例慢性髓细胞白血病患者中2例使用羟基脲治疗,1例短期服用伊马替尼,1例行白细胞单采术治疗,1例行血小板单采术治疗,另1例临产入院未治疗.(2)妊娠结局:妊娠期死亡1例,余22例分娩.平均终止妊娠孕周(38.3±2.3)周,21例活产新生儿平均出生体重为(2 755±486)g.妊娠期并发子痫前期5例,弥漫性血管内凝血2例,胎盘早剥1例.产后出血5例,平均出血(1 200±751) ml,产褥感染2例,孕产妇死亡1例.围产儿23例,其中早产儿4例,低出生体重儿4例,死胎2例,伴出生缺陷1例,伴血常规异常2例.8例剖宫产分娩,2例产钳助产分娩,12例阴道分娩.(3)随访情况:妊娠期死亡1例,其余22例失访4例,余1 8例随访3个月～13年,母亲存活11例,因原发病死亡7例,新生儿均发育正常. 结论 妊娠合并白血病是极度高危的产科情况,但对有生育要求的患者,在一定条件下仍有望获得较好的妊娠结局.
目的 探討妊娠閤併白血病患者的母兒結跼. 方法 選擇1980年6月1日至201 1年7月31日北京大學人民醫院產科收治的進入圍產期的23例妊娠閤併白血病患者,包括妊娠前診斷的白血病9例(4例急性髓細胞白血病,5例慢性髓細胞白血病)和妊娠期首次診斷的白血病患者14例,其中急性白血病8例(急性髓細胞白血病7例,急性淋巴細胞白血病1例),慢性髓細胞白血病(慢性期)6例納入研究,採用迴顧性方法對其妊娠期臨床處理、妊娠結跼進行分析,併對母兒情況進行隨訪. 結果 (1)妊娠期臨床處理:妊娠前診斷的4例急性髓細胞白血病患者中2例妊娠前已停化療藥物≥5年,另2例病情完全緩解,妊娠期病情均無複髮,無特殊處理;5例妊娠前診斷的慢性髓細胞白血病患者血常規鑑測異常,但妊娠期疾病仍一直處于慢性期,妊娠期1例使用羥基脲治療,1例使用伊馬替尼,餘3例無任何治療.14例妊娠期首次診斷的白血病患者中,血常規檢查均有白細胞異常,其中9例同時伴有貧血和血小闆計數異常,4例伴單一貧血或血小闆計數異常.8例急性白血病患者中除1例因妊娠40週和1例髮生死胎未進行化療外,6例進行瞭化療.6例慢性髓細胞白血病患者中2例使用羥基脲治療,1例短期服用伊馬替尼,1例行白細胞單採術治療,1例行血小闆單採術治療,另1例臨產入院未治療.(2)妊娠結跼:妊娠期死亡1例,餘22例分娩.平均終止妊娠孕週(38.3±2.3)週,21例活產新生兒平均齣生體重為(2 755±486)g.妊娠期併髮子癇前期5例,瀰漫性血管內凝血2例,胎盤早剝1例.產後齣血5例,平均齣血(1 200±751) ml,產褥感染2例,孕產婦死亡1例.圍產兒23例,其中早產兒4例,低齣生體重兒4例,死胎2例,伴齣生缺陷1例,伴血常規異常2例.8例剖宮產分娩,2例產鉗助產分娩,12例陰道分娩.(3)隨訪情況:妊娠期死亡1例,其餘22例失訪4例,餘1 8例隨訪3箇月～13年,母親存活11例,因原髮病死亡7例,新生兒均髮育正常. 結論 妊娠閤併白血病是極度高危的產科情況,但對有生育要求的患者,在一定條件下仍有望穫得較好的妊娠結跼.
목적 탐토임신합병백혈병환자적모인결국. 방법 선택1980년6월1일지201 1년7월31일북경대학인민의원산과수치적진입위산기적23례임신합병백혈병환자,포괄임신전진단적백혈병9례(4례급성수세포백혈병,5례만성수세포백혈병)화임신기수차진단적백혈병환자14례,기중급성백혈병8례(급성수세포백혈병7례,급성림파세포백혈병1례),만성수세포백혈병(만성기)6례납입연구,채용회고성방법대기임신기림상처리、임신결국진행분석,병대모인정황진행수방. 결과 (1)임신기림상처리:임신전진단적4례급성수세포백혈병환자중2례임신전이정화료약물≥5년,령2례병정완전완해,임신기병정균무복발,무특수처리;5례임신전진단적만성수세포백혈병환자혈상규감측이상,단임신기질병잉일직처우만성기,임신기1례사용간기뇨치료,1례사용이마체니,여3례무임하치료.14례임신기수차진단적백혈병환자중,혈상규검사균유백세포이상,기중9례동시반유빈혈화혈소판계수이상,4례반단일빈혈혹혈소판계수이상.8례급성백혈병환자중제1례인임신40주화1례발생사태미진행화료외,6례진행료화료.6례만성수세포백혈병환자중2례사용간기뇨치료,1례단기복용이마체니,1례행백세포단채술치료,1례행혈소판단채술치료,령1례임산입원미치료.(2)임신결국:임신기사망1례,여22례분면.평균종지임신잉주(38.3±2.3)주,21례활산신생인평균출생체중위(2 755±486)g.임신기병발자간전기5례,미만성혈관내응혈2례,태반조박1례.산후출혈5례,평균출혈(1 200±751) ml,산욕감염2례,잉산부사망1례.위산인23례,기중조산인4례,저출생체중인4례,사태2례,반출생결함1례,반혈상규이상2례.8례부궁산분면,2례산겸조산분면,12례음도분면.(3)수방정황:임신기사망1례,기여22례실방4례,여1 8례수방3개월～13년,모친존활11례,인원발병사망7례,신생인균발육정상. 결론 임신합병백혈병시겁도고위적산과정황,단대유생육요구적환자,재일정조건하잉유망획득교호적임신결국.
Objective To investigate the perinatal outcomes and management of pregnancy with leukemia.Methods From June 1,1980 to July 31,2011,23 pregnant women with leukemia,were admitted to the Department of Obstetrics of Peking University People's Hospital.Clinical data of these women were collected and analyzed retrospectively.Among the 23 cases,nine were diagnosed before pregnancy including four with acute myeloid leukemia (AML) and five with chronic myeloid leukemia (CML),and 14 diagnosed during pregnancy including eight with acute leukemia (AL) [seven with AML and one with acute lymphocytic leukemia (ALL)] and six with CML.The prognosis of the mothers and infants were followed up.Results (1)Managements during pregnancy:For the four cases with AML,two were completely recovered and the other two had completed chemotherapy five years before pregnancy,and no relapse was reported during pregnancy.The other five cases with CML were stable during pregnancy although the results of blood routine tests were abnormal.Among them,one case was treated with hydroxyurea and one with imatinib during pregnancy,while the other three women received no treatment.For those 14 cases diagnosed during pregnancy,all were recorded with abnormal white blood counts,and nine complicated with anemia and abnormal platelet count and four with either anemia or abnormal platelet count.Among the eight cases with AL,six received chemotherapy during pregnancy and two did not due to intrauterine fetal death and 40 weeks of gestation on admission,respectively.For the six CML women,two received hydroxyurea,one took imatinib,one took leukapheresis and one accepted plateletpheresis during pregnancy,but one woman received no treatment due to regular contractions on admission.(2) Perinatal outcomes:The average gestational weeks on delivery was (38.3±2.3) weeks,and the average birth weight of newborns was (2 755 ±486) g.There were two cases of disseminated intravascular coagulation,five pre-eclampsia and one placental abruption during pregnancy.Five women were complicated with postpartum hemorrhage [average bleeding volume was (1 200± 751) ml] and two cases of puerperal infection.One pregnant woman died.Among the 23 perinatal infants,there were four premature infants,four low birth weight infants,two still births,one with congenital malformations,and two infants had abnormal blood routine tests.Eight babies were delivered by caesarean section,12 through vagina and two required forceps assistants.(3) Follow-ups:Except for one woman died during pregnancy,four of the other 22 cases were lost.Among the rest 18 cases with the follow-up from three months to 13 years,11 women survived and seven died due to leukemia.All newborns were healthy.Conclusions Pregnancy with leukemia is an extremely high-risk obstetric condition,but for patients with bearing requirement,better perinatal outcome might be achieved under proper management.
