CAJ | 학술논문

目的探讨妊娠合并脑神经胶质细胞瘤(简称脑胶质瘤)的临床处理. 方法回顾性分析首都医科大学宣武医院1989年1月至2012年12月收治的11例妊娠合并脑胶质瘤患者的临床资料. 结果 11例患者均于妊娠期首次诊断为脑胶质瘤,其中妊娠早期诊断2例,妊娠中期诊断4例,妊娠晚期诊断5例.主要有头晕、头痛、恶心呕吐等颅内高压的表现伴癫痫及视物不清、听力减退、言语障碍等其他神经功能障碍的表现.11例患者中1例未行产科处理,5例行剖宫产,3例中期引产,1例人工流产,1例自然流产.共10例患者行开颅手术,术后病理为低级别胶质瘤4例,高级别胶质瘤6例.其中3例患者在接受开颅手术前终止妊娠,4例患者剖宫产后即行开颅手术,2例在开颅手术后终止妊娠,1例因病情危重入院后急诊行开颅手术,未行产科处理.共分娩新生儿5例,外观正常无畸形,其中4例存活,1例因重度窒息死亡.10例行开颅手术患者中,1例术后持续昏迷50 d后死亡,1例失访,6例行放疗+化疗,1例行单纯化疗,1例未行放化疗.11例患者中1例未行开颅手术者剖宫产术后失访,其余10例中1例低级别胶质瘤患者术后50 d死亡,1例开颅手术后失访;8例患者术后随访4个月～3年,其中4例存活,4例高级别脑胶质瘤患者术后1年内死亡. 结论妊娠合并脑胶质瘤患者的总体预后不良,应充分评估孕母的肿瘤情况、孕周、胎儿成熟度以及妊娠意愿,权衡利弊,适时终止妊娠并进行神经外科手术治疗.
목적 탐토임신합병뇌신경효질세포류(간칭뇌효질류)적림상처리. 방법 회고성분석수도의과대학선무의원1989년1월지2012년12월수치적11례임신합병뇌효질류환자적림상자료. 결과 11례환자균우임신기수차진단위뇌효질류,기중임신조기진단2례,임신중기진단4례,임신만기진단5례.주요유두훈、두통、악심구토등로내고압적표현반전간급시물불청、은력감퇴、언어장애등기타신경공능장애적표현.11례환자중1례미행산과처리,5례행부궁산,3례중기인산,1례인공유산,1례자연유산.공10례환자행개로수술,술후병리위저급별효질류4례,고급별효질류6례.기중3례환자재접수개로수술전종지임신,4례환자부궁산후즉행개로수술,2례재개로수술후종지임신,1례인병정위중입원후급진행개로수술,미행산과처리.공분면신생인5례,외관정상무기형,기중4례존활,1례인중도질식사망.10례행개로수술환자중,1례술후지속혼미50 d후사망,1례실방,6례행방료+화료,1례행단순화료,1례미행방화료.11례환자중1례미행개로수술자부궁산술후실방,기여10례중1례저급별효질류환자술후50 d사망,1례개로수술후실방;8례환자술후수방4개월～3년,기중4례존활,4례고급별뇌효질류환자술후1년내사망. 결론 임신합병뇌효질류환자적총체예후불량,응충분평고잉모적종류정황、잉주、태인성숙도이급임신의원,권형리폐,괄시종지임신병진행신경외과수술치료.
Objective To explore the management of gliomas in pregnant women.Methods We retrospectively analyzed the clinical data in 11 pregnant women with gliomas treated at Xuanwu Hospital of Capital Medical University between January 1989 and December 2012.Results All the patients were first diagnosed with gliomas during pregnancy,including two cases during early pregnancy,four cases during midpregnancy,and five cases during late pregnancy.The main clinical manifestations were dizziness,headache,nausea and vomiting due to intracranial hypertension,accompanied by epilepsy and blurred vision,hearing and speech disorder and other neurological dysfunctions.Among the 11 patients,one received no obstetric treatment,five underwent cesarean section,three had metaphase induced labor,one had induced abortion,and one had spontaneous abortion.Five neonates appeared normal without malformation:four survived,and one with severe asphyxia died.Ten patients underwent neurosurgery,four of them were diagnosed with low-grade gliomas and six were diagnosed with high-grade glioma by pathology.Seven patients received craniotomy after termination of pregnancy,two underwent craniotomy before termination of pregnancy,and one received emergency craniotomy immediately after admission without obstetric treatment because of her critical conditions.Of the ten patients treated with craniotomy,one died after a coma for 50 days,one was lost to follow-up,six received radiotherapy plus chemotherapy,one received chemotherapy alone,and one received neither radiotherapy nor chemotherapy.Among the 11 patients,one patient who underwent cesarean section without craniotomy was lost to follow-up,one patient with low-grade glioma died 50 days after operation,one treated with craniotomy was lost to follow-up,and eight were followed up for four months to three years,among which four survived and four with high-grade glioma died within one year after operation.Conclusion The overall prognosis of glioma patients during pregnancy is poor.It is important to take into account the tumor status of the pregnant women,gestational age,fetal maturity and patient's desire for tocolysis,and weigh the pros and cons,and timely terminate pregnancy and perform neurosurgery.