摘要
目的探讨妊娠期合并颅内肿瘤患者的围手术期管理。方法回顾性纳入2012年12月至2017年12月首都医科大学附属北京天坛医院收治的妊娠期合并颅内肿瘤患者,共19例。其中孕早期(≤12周)1例,孕中期(13~28周)9例,孕晚期(>28周)9例。由神经内科、神经外科、产科、麻醉科及儿科共同制定手术、麻醉及新生儿管理方案。共12例患者行神经外科手术治疗,6例先行剖宫产术后行颅内肿瘤切除术或第三脑室底造瘘术(1例),其中一期治疗2例,剖宫产术后5~16d行神经外科治疗4例;3例良性肿瘤患者肿瘤切除术后继续妊娠;3例肿瘤切除术后终止妊娠。7例未行神经外科手术治疗,其中3例为垂体腺瘤患者,继续妊娠至足月行剖宫产手术;4例外科手术风险较大者,剖宫产后行神经外科保守治疗。结果19例患者均无麻醉相关并发症。围手术期颅内感染2例,电解质紊乱2例,脑积水3例,肺部感染1例。孕妇院内死亡1例;术后随访8~23个月,平均(13.3±3.5)个月,随访期死亡3例。4例死亡者均为肿瘤未切除者。其余患者病情稳定。共分娩新生儿16名,分娩时孕周25~40周,出生Apgar评分为2~10分,平均(8.8±2.2)分。其中15名临床结局良好,1例出生1个月后死亡(孕周28周)。结论多学科协作、围手术期个体化管理是提高妊娠合并颅内肿瘤患者母胎安全的合理治疗方案。
Objective To investigate the outcomes in patients with pregnancy complicated with intracranial tumors who underwent comprehensive management.Methods We retrospectively reviewed the clinical data,anesthesia management and outcome of pregnant women complicated with intracranial tumor admitted to Beijing Tiantan Hospital,Capital Medical University from December 2012 to December 2017 and 19 cases were enrolled into this study.One case was at the first trimester (≤12 weeks),9 at the second trimester (13-28 weeks)and 9at the third trimester (>28 weeks).The operation,anesthesia and newborn management for pregnancy with brain tumor is a multidisciplinary teamwork of neurology, neurosurgery,obstetrics and anesthesiology for both mothers and newborns.Twelve cases underwent neurosurgieal treatment,among which 6 cases underwent cesarean section followed by brain tumor resection or ventriculostomy (1 case).Among those 6 cases,2 underwent surgical treatment at the first stage and 4 underwent surgical treatment 5 to 16 days later.Three benign cases carried on pregnancy after tumor resection.Pregnancy was terminated after tumor resection in 3 cases.A total of 7 cases were conservatively treated,among which 3 had the pituitary tumor and were observed till the cesarean section surgery at full term.The other 4 cases with relatively high surgical risks underwent conservative treatment following cesarean section.Results There were no anesthetic complications in this series.There were 2 cases of intracranial infection,2cases of electrolyte disorder,1 case of hydrocephalus and 1 case of pneumonia. There was 1 case of inhospital death in pregnant women.Postoperative follow-up lasted for 8-23 months, with an average of 13.3±3.5 months.There were 3 deaths during the follow-up period.All those 4 cases were patients without resection of tumor.The rest of the patients were in stable condition.There were a total of 16newborns who were 25-40 weeks of gestation at childbirth.The Apgar scores at birth were 2-10 points,with an average of 8.8±2.2 points.Of those,15 had good clinical outcomes and 1 died 1 months after birth (28 weeks gestation week ).Conclusion Individualized perioperative multidisciplinary management for pregnant women complicated with brain tumor might be the optimal approach to secure post-operative outcome of patients and newborns.
作者
李妹
彭宇明
梁发
梁辉
王博
黄春玉
张彤
何颖
韩如泉
Li Shu;Peng Yuming;Liang Fa;Liang Hui;Wang Bo;Huang Chunyu;Zhang Tong;He-Ying;Han Ruquan(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第12期1254-1257,共4页
Chinese Journal of Neurosurgery
基金
北京市医院管理局“青苗基金”(QML20150508)
首都特色发展基金(ZYLX201708).
关键词
脑肿瘤
妊娠
围术期管理
Brain tumor
Pregnancy
Perioperative management
