妊娠合并白血病21例临床分析

目的探讨妊娠合并白血病的治疗原则。方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,选择分娩方式,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。

Clinical analysis of 21 patients with leukaemia complicating pregnancy

Objective To investigate the treatment of leukaemia complicating pregnancy.Methods Clinical data of 21 pregnant patients complicated with leukaemia who were treated in Peking university People＇s hospital from Feb.1980 to Dec.2009 were analyzed retrospectively.Results There are totally 23 pregnancies in these 21 patients.8 patients were diagnosed with leukaemia before gestation.5 were diagnosed in the first trimester,3 in the second trimester and 7 in the third trimester.4 patients were ended with therapeutic abortion in the first trimester,3 were induced abortion in the second trimester,1 were induced abortion in the third trimester for still birth.12 patients were termed delivery,including 6 deliveried via vagina,2 with forceps assisted,4 underwent caesarean section.1 patient had hysterectomy during caesarean section due to heavy hemorrhage.11 patients were treated with chemotherapy,1 died during pregnancy.4 patients lost follow-up,7 died after delivery.Conclusions Patients with leukaemia should cured before pregnancy;therapeutic abortion should be offered to patients with acute leukaemia during the first and second trimester;patients who get leukaemia during the third semester can continue pregnancy while administering combined chemotherapy.We should choose different way of delivery according to blood routine tests and states.During labor,emergency equipment should be prepared in order to avoid bleeding,infection,complication or death.The most important prognostic factor is diagnoseing timely and giring intensive chemotherapy as early as possible.