晚期妊娠合并原发性肝癌3例临床研究.docVIP

晚期妊娠合并原发性肝癌3例临床研究【摘要】 目的 探讨晚期妊娠合并原发性肝癌的病史特点、诊断及治疗。方法 对中山大学附属第三医院2004年7月至2009年6月晚期妊娠合并原发性肝癌3例病例进行回顾性分析。结果 3例患者确诊肝癌时均系妊娠晚期,诊断方法包括超声、CT或核磁共振、病理检查,治疗均采用子宫下段剖宫产术并肝胆外科医师术中会诊,3例患者术后均行放射介入治疗。结论 妊娠合并原发性肝癌病情发展快,及时诊断与治疗可改善母婴预后。 【关键词】 妊娠;原发性肝癌;诊断;治疗 Clinical analysis of 3 cases of late pregnancy with primary hepatic carcinoma HOU Hong-ying,HAO Xiu-lan,WU Ling-ing,et al.The Third Affiliated Hospital Of Sun Yat-sen University,Guangdong 510630,China 【Abstract】 Objective To evaluate the characteristics, diagnosis and treatment of late pregnancy with primary hepatic carcinoma.Methods From July 2004 to June 2006, 3 cases of late pregnancy with primary hepatic carcinoma in the third affiliated hospital of sun yat-sen university were analyzed retrospectively.Results All of the cases were diagnosed primary hepatic carcinoma in late pregnancy. Ultrasound, CT, MRI, and pathology were the diagnostic methods. All of the cases undergoing cesarean section were consulted by hepatobiliary surgeon during the operation, and given radioactive interventional therapy after operation.Conclusion He disease progression of pregnancy with primary hepatic carcinoma is rapid. The in-time diagnosis and treatment can improve the outcomes of mother and infant. 【Key words】 Pregnancy; Primary hepatic carcinoma;Diagnosis;Treatment 肝癌是我国常见的恶性肿瘤之一,由于妊娠期的器官与生理变化,增加了妊娠合并原发性肝癌的诊断难度,并且病情进展快、治疗难度大、疗效差,因此母儿预后不良。对3例晚期妊娠合并原发性肝癌进行分析如下。 1 临床资料 例1:患者35岁,孕2产1,因“停经34+周,突发下腹痛半天”转入我院,孕期未产检,足月顺产1次。入院:T:36.8℃,R:19次/min,P:150次/min,BP:85/65 mm Hg,腹壁张力大,肝界不清。压痛反跳痛(+),移动性浊音(+),宫高*腹围:30 cm×92 cm,触规律宫缩,宫口未开。彩超提示:死胎,羊水极少,中等腹水。肝功能指标未见异常。 例2:患者32岁,孕2产1,因“停经37+周,反复右上腹痛半个月”转入我院,不规则产检,HBsAg阳性10多年,乙肝小三阳2年。入院查体:T:36.5℃,R:18次/min,P:78次/min,BP:110/68 mm Hg,剑突下及右上腹压痛(+),无反跳痛,肝肋下触及增大,压痛(+),宫高*腹围:39*101 cm,胎心147次/分,头先露,宫口未开。彩超提示:左肝实性病变74*67 mm,右肝前叶病变135*122 mm,肝癌可能;门静脉左支、右前叶支及矢状部癌栓可能;脾大,少-中量腹水;胎儿足月大小。血清AFP1000ng/ml,肝酶、胆红素轻度升高。 例3:患者36岁,孕5产1,“停经31+2?周,下腹痛1天”转入我院,不定期产检。自幼乙肝小三阳,足月剖宫产1次,入院体查:T:36.2℃,R:18次/min,P:88次/min,BP:1