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病例32-2018:一名新诊断腺癌的36岁孕妇
Case 32-2018 — A 36-Year-Old Pregnant Woman with Newly Diagnosed Adenocarcinoma


Janet E. Murphy ... 肿瘤 妇产科和儿科 • 2018.10.18

如何诊治罹患肿瘤的孕妇——来自麻省总医院的启示

 

侯悦,乔宠*,谭季春*

中国医科大学附属盛京医院妇产科

*通讯作者

 

在过去几十年,妊娠期并发恶性肿瘤越来越多,现在报道的妊娠期并发恶性肿瘤的发病率为1/1,0001。妊娠期确诊的恶性肿瘤较常见的是乳腺癌、卵巢癌、宫颈癌及黑色素瘤2等,妊娠并发结直肠癌非常少见,结直肠癌在妊娠人群中的发病率约1/13,0003。结直肠癌是一种老年病,其平均的诊断年龄为68岁4。流行病数据显示近期结直肠癌在年轻患者中的发病率明显增加,尤其是35~49岁5,随育龄期妇女生育年龄的增大,结直肠癌在妊娠期妇女的发病也逐年增加。

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病历陈述


Malavika Prabhu医师(妇产科):一名36岁孕妇因新诊断的腺癌在妊娠33周时于本院接受了评估。

在入院前7个月,当患者进行初次例行产前检查时,经阴道超声检查显示孕囊和胚胎正常。此后,产前随访平安无事,尽管患者在妊娠27周的1小时葡萄糖耐量试验结果异常。

在此次评估前一周,即妊娠32周时,患者出现无放射的重度腰痛3日,患者对腰痛的评分为10分(评分范围为0~10分,10分表示最严重的疼痛)。疼痛始于腹上区,随后移行至右上腹和腰部。疼痛伴有重度恶心,进食任何食物或液体均发生呕吐。患者有盗汗,并且背部疼痛导致难以入睡。疼痛开始后4日,患者被收入另一家医院的产科。





作者信息

Janet E. Murphy, M.D., M.P.H., Kimberly Shampain, M.D., Laura E. Riley, M.D., Jeffrey W. Clark, M.D., and Kristen M. Basnet, M.D.
From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School — both in Boston.

 

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