妊娠合并肺癌二例并文献复习

目的 提高对妊娠合并肺癌临床表现的认识.方法 分析南方医科大学南方医院收治的2例妊娠合并肺癌患者的临床表现、诊断及治疗经过,并结合文献进行讨论.结果 第1例患者31岁,妊娠34周,X线胸片示右侧胸腔积液.于妊娠35周行剖宫术产出男婴1名,同时进行右锁骨上淋巴结活检,病理检查提示转移性肺大细胞未分化癌.产后第2天患者病情持续恶化,给予机械通气及抗生素、吉非替尼治疗无效,产后28 d死亡.第2例患者28岁,妊娠27周,正电子发射计算机断层扫描示右侧肺癌合并心包、右侧胸膜、肝脏及盆腔转移.气管镜活检病理结果提示肺小细胞未分化癌.人工终止妊娠后,给予足叶乙甙+顺铂(EP方案)化疗2个周期后病变缩小,患者转回当地医院.结论 妊娠合并肺癌少见,患者预后较差.为改善孕妇的预后及减少胎儿转移,需要在权衡利弊的情况下进行适当的全身抗肿瘤治疗.

Lung cancer in pregnancy: report of two cases and review of literature

Objective To raise awareness about lung caner in pregnancy.Methods The clinical presentations,diagnosis and treatment of 2 cases of lung caner in pregnancy were reported,and related literatures were reviewed.Results The first case was a 31-year-old pregnant woman at 34th-week gestation,who presented with fight sided pleural effusion on a Chest X-ray film A boy was delivered by Cesarean section at 35 weeks of gestation.Biopsy of the right-supraelavicular lymph node was performed simultaneously,and histopathological examination showed metastatic large cell lung cancer.Her respiratory condition worsened after the Caesarian section,and so mechanical ventilation,antibiotics and gefitinib were administered,but the treatment failed.She died on the 28th day after Caesarian section.The second case was a 28-year-old pregnant woman at the 27 week of gestation.PET showed right lung cancer with metastases to the pericardium,right pleura,liver and pelvic cavity.Bronchoscopic biopsy showed small-cell lung cancer.After pregnancy termination,the patient received 2 cycles of chemotherapy consisting of cisplatin and etoposide.The size of lesions decreased and the patient returned to the local hospital.Conclusions Lung cancer in pregnancy is a rare condition with poor prognosis.To improve the prognosis and prevent the metastasis to the fetus,systemic therapy should be considered,and meanwhile maternal advantage must be always weighed against possible embryo-fetal risks.