妊娠合并急性白血病一例临床分析

目的：探讨妊娠合并急性白血病的临床特点，以提高对该疾病的诊治水平，改善母婴不良结局。方法：回顾性分析南方医科大学深圳医院收治的1 例妊娠晚期合并急性髓系白血病患者的诊治过程，并结合相关文献对该疾病进行分析。结果：本例患者于妊娠晚期发现急性髓系白血病，给予纠正贫血、促胎肺成熟、保护脑神经细胞等对症处理，于妊娠32＋1周行子宫下段剖宫产术娩出一活女婴。术后行白血病常规化疗。文献显示妊娠早期发现白血病应立即终止妊娠后进行常规白血病治疗；妊娠中晚期暴露于化疗药物会增加胎儿生长受限和早产的风险，但并不增加胎儿畸形的风险，可根据孕周大小制定治疗方案。结论：妊娠合并白血病的治疗应兼顾疾病本身、母体、胎儿及患者意愿等多方面因素，需要多学科团队合作，选择最佳的治疗方案以降低孕产妇不良妊娠结局的发生风险。

A Clinical Analysis of Pregnancy with Acute Leukemia

Objective：To investigate the clinical features of pregnancy complicated with acute leukemia, in order to improve the diagnosis and treatment level of the disease. Methods：To analyze retrospectively the diagnosis and treatment process of 1 case with acute myeloid leukemia, and refer to related literature. Results：In this case, acute myeloid leukemia was found in the late pregnancy. After correcting anemia, promoting fetal lung maturity, protecting brain nerve cells and other symptomatic treatment, the patient bore a live baby girl in caesarean section at 32+1 week of gestation. Then she recevied a series of standard chemotherapy. The literatures show that patients diagnosed with acute leukaemia during the first trimester are recommended to terminate pregnancy. Exposure to chemotherapeutic drugs in the second and third days of pregnancy will increase the risk of intrauterine growth restriction and premature birth, but it does not increase the risk of fetal malformation. A treatment plan can be made according to the gestational week. Conclusions：The treatment of pregnancy combined with leukemia should take account of various factors such as disease itself, mother, fetus and patient's wishes. It is necessary for multidisciplinary team cooperation to choose the best treatment plan to reduce the incidence of adverse pregnancy outcomes.