Concomitant Digestive Malignancy in Pregnancy

懷孕期發生消化道惡性腫瘤是非常罕見的，馬偕醫院從72年6月至81年4月間，共搜集上述病人13例，其中8例為大腸癌，2例為胃癌，3例為原發性肝細胞癌，加以廣泛地整理、分析、探討各種消化道腫瘤併發於妊娠期的臨床表徵，診斷與治療及母子預後。懷孕期大便出血，排便習慣改變並不一定意謂著是痔瘡或正常懷孕所造成，必需充分了解懷孕合併大腸癌的可能性，方可早期診斷、治療。食慾不振、噁心、嘔吐、上腹痛，在懷孕期間是相當常見的症狀，也是胃癌的臨床表徵，由於X－光檢查對胎兒有一定的傷害；所以胃內視鏡術及腹部超音波檢查，成為診斷胃癌重要的工具，而本研究中3例原發性肝細胞癌，第l例在無症狀下產前檢查，發現甲型胎兒蛋白不正常上昇，而得以早期診斷。第2例因腹痛，肝腫大於妊娠24週時察覺。第3例在產後一週因腹痛、發燒及鼻衄，進一步檢查後而診斷之，在本篇中3例皆呈HBsAg陽性合併肝硬化，本研究也發現，13位胎兒有6位死亡，原因分別為3位接受治療性流產，2位早產，1位妊娠死產。另外13位母親中，亦有6位死亡，分別是2位妊娠大腸癌，一位妊娠胃癌，3位妊娠肝細胞癌。在往後追蹤期間，並未發現有胎兒受到母親腫瘤轉移的情形。一般說來，消化道腫瘤好發於50歲以上的年齡層，所以併發於育齡婦女的機會相當少見，加上消化道腫瘤的臨床表徵，甚似於正常妊娠的生理現象，易被朦蔽疏忽而無法早期診斷，故惟有高度的警覺腫瘤存在的可能，方能早期診斷與治療，得以改善母子的存活率。

關鍵字

懷孕（妊娠）；胃癌；大腸癌；肝細胞癌

並列摘要

Cancer of the digestive organs occurring during pregnancy is uncommon. To date, there have been fewer than 250 cases of pregnancy associated with alimentary tract carcinoma presented in the literature, the estimated incidence being one in 100,000 pregnancies. From January 1983 through April 1992, we enrolled in our study 13 cases of digestive tract cancer during pregnancy including 8 cases of colorectal cancer, 2 cases of gastric cancer, and 3 cases of hepatocellular carcinoma. Herein, the clinical manifestations, diagnosis, treatment, and prognosis of each pregnant patient as well as the fetus are reviewed. The presenting symptoms in these patients, including nausea, vomiting, abdominal fullness or pain, non-specific dyspepsia, constipation, and rectal bleeding, were often confused with the physiological features of pregnancy. Therefore, the major difficulty in diagnosis of cancer is that the presenting symptoms of pregnancy overshadow the non-specific symptoms of early alimentary tract cancer. This report may help to remind clinicians of the possibility of cancer during pregnancy.

並列關鍵字

Pregnancy ； Gastric cancer ； Colorectal cancer ； Hepatocellular carcinoma

國際替代計量

Concomitant Digestive Malignancy in Pregnancy

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