Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases.
Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases.
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DOI：
10.1016/j.ijscr.2014.06.003
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发表时间：
2014
影响因子：
0.6
通讯作者：
Wu MC
中科院分区：
文献类型：
--
作者：
Li AJ;Zhou WP;Lu JH;Cui LJ;Yang XY;Yin L;Wu MC
妊娠期发生肝细胞癌是相当罕见的。由于诊断延误，预后通常很差。报道的妊娠期HCC病例大多是孤立的，没有丰富的经验。因此，妊娠对HCC患者预后的影响以及妊娠期发生HCC的危险因素并没有很好的文献记载。我们的目的是回顾我们治疗4例年轻妊娠HCC的经验。手术前进行了实验室检查。我们分析了年龄、乙型肝炎表面抗原状态、分娩时肝硬化、胎儿胎龄和产妇结局的影响。甲胎蛋白（AFP）水平升高对诊断有一定的帮助。3例患者因HCC复发在5个月、6个月和24个月死亡，另1例患者术后12个月无疾病存活。妊娠期肝细胞癌的手术应与非妊娠期相似。完全切除肿瘤而不终止妊娠为妊娠期HCC妇女提供了最大的生存机会，但这取决于胎儿的胎龄。需要辅助治疗来改善这类手术的长期效果。孕周28周是胎儿成熟的临界点，是决定是否终止妊娠的关键。我们的两名患者在确诊HCC自发性破裂后终止妊娠，以挽救母亲的生命。
Hepatocellular carcinoma (HCC) occurring in pregnancy is quite rare. The prognosis is usually poor because of a delay in diagnosis. Reported cases of HCC in pregnancy are largely isolated with no large experience. Thus the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Our aim was to review our experience with management of four young pregnant women with HCC. Laboratory tests were performed before surgery. We analyzed the effects of age, hepatitis B surface antigens status, cirrhosis at presentation, gestational age of fetus, and maternal outcome. Increase in alpha-fetoprotein (AFP) level was somewhat useful for diagnosis. Three patients died in 5 months, 6 months, and 24 months from HCC recurrence, and another patient is alive without disease 12 months postoperatively. Surgery for HCC during pregnancy should be similar to that for non-pregnant women. Complete excision of tumor without termination of pregnancy provides the greatest chance of survival for women with HCC during pregnancy but depends on gestational age of the fetus. Adjuvant treatments are required to improve the long-term results of this type of surgery. The 28-week gestational week is a critical point of fetal maturation which is very important in deciding whether pregnancy should be terminated or not. The pregnancy was terminated in two of our patients when spontaneous rupture of HCC was diagnosed to save the mother's life.