妊娠合并白血病21例临床分析.PDFVIP

中国妇产科临床杂志2010 年7 月第 11 卷 第4 期　Chin J Clin Obstet Gynecol　July 　2010, Vol.11, No.4 ·249 · ·论著 · 妊娠合并白血病21 例临床分析 白月婷　　江倩　　王山米 　　【摘要】 　目的　探讨妊娠合并白血病的治疗原则。 法　回顾性分析北京大学人民医院妇产科 1980 年2 月至2009 年12 月收治的21 例妊娠合并白血病患者的临床资料。 结果　21 例妊娠 23 次, 孕前诊断8 例次, 孕 期诊断分别于孕早、 中、 晚期各5、 3、 7 例次。 孕早期治疗性流产4 例次, 1 例早孕化疗转院失访, 1 例早期子 宫切除术, 孕中期引产3 例次, 孕32 周死胎引产 1例次;足月妊娠10 例次, 6 例次阴道顺产, 2 例次产钳助产, 2 例次剖宫产, 其中1 例次因出血同时行子宫次全切除术;2 例次早产剖宫产。 妊娠期间化疗 11 例次, 死亡1 例 (未分娩)。失访4 例, 产后死亡 7 例。 结论　孕前诊断为白血病者, 应积极治疗, 待病情完全缓解后怀孕, 孕 期常病情复发;孕早、 中期合并急性白血病患者, 应行治疗性流产/引产后积极抗白血病治疗;孕晚期发病者, 可给予化疗, 争取在短期内完全缓解;根据产时血象及产科情况, 选择分娩 式, 产时防止出血、 感染及心脑 血管等并发症的发生;影响预后的最关键的因素是充分认识疾病、 及时诊断和积极治疗。 【关键词】　妊娠;白血病 Clinical analysis of 21 patients with leukaemia complicating pregnancy BA I Y ueting, JIANG Qian, WA NG Shanmi. (Dep arttrmentof Obstetrics and Gynecology, eking University eop leshosp ital, Beij ng 10044, China ) 【Abstract】　Objective 　To investigate the t reatment of leukaemia complicating pregnancy.Methods　Clinical ata of 21 pregnant patients complicate with leukaemia who w ere treate in Peking university Peoples hospital from Feb.1980 to Dec.2009 were analyze retrospectively.Results 　There are totally 23 pregnancies in these 21 patients. 8 patients were iagnose with leukaemia before gestation.5 w ere iagnose in the first trimester, 3 in the secon trimester an 7 in the thir trimester.4 patients were en e with therapeutic abortion in the first trimester, 3 were in uce abortion in the secon t rimester, 1 were in uce abortion in the thir trimester for still birth.12 patients were terme elivery, inclu ing 6 eliverie via vagina, 2 with forceps assiste , 4 un erwen