| 摘要: |
| ［摘要］ 随着恶性肿瘤发病年轻化，妊娠合并恶性肿瘤发病率上升，成为产科复杂难题，核心矛盾是平衡母体肿瘤治疗与胎儿安全。该文结合临床实践与指南进展，系统探讨其诊疗策略。妊娠生理变化易与肿瘤早期症状混淆，致诊断延迟、分期偏晚。早期诊断关键在于精准鉴别异常信号，对高危人群孕前筛查、孕期分层评估，以病理活检为确诊金标准。影像学检查遵循合理可行尽量低（ALARA）原则，首选超声与无钆磁共振成像（MRI），严格限制电离辐射检查。治疗以母体安全为先，孕中期为手术与化疗最佳窗口期；化疗避开孕早期，选用蒽环类、铂类等低风险药，禁用致畸药物；放疗在妊娠期为禁忌，仅少数特例谨慎实施。全程依托多学科协作（MDT）制订个体化方案。分娩需评估母胎状况，产后衔接肿瘤治疗并长期随访母儿健康。规范诊疗与MDT模式可改善母胎结局，为生育期女性提供安全保障。 |
| 关键词: 妊娠 恶性肿瘤 多学科协作 放化疗 诊疗策略 |
| DOI：10.3969/j.issn.1674-3806.2026.06.01 |
| 分类号:R 73 |
| 基金项目: |
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| Diagnostic and therapeutic characteristics and clinical reflections on pregnancy complicated by malignant tumors |
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SONG Zhaoli, LIN Li
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Diagnostic and therapeutic characteristics and clinical reflections on pregnancy complicated by malignant tumors
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| Abstract: |
| ［Abstract］ As malignant tumors become more prevalent among younger populations, the incidence of pregnancy complicated by malignant tumors has risen, posing a complex clinical challenge in obstetrics. The core of the dilemma to the disease lies in balancing maternal oncological treatment and fetal safety. This paper systematically discusses the diagnosis and treatment strategies based on clinical practice and updated guidelines. Physiological changes during pregnancy can easily be confused with early tumor symptoms, resulting in delayed diagnosis and advanced staging. The key to early diagnosis is the accurate identification of abnormal signals, including pre-pregnancy screening for high-risk individuals and stratified assessment during pregnancy, with pathological biopsy as the gold standard for the confirmed diagnosis. Imaging examinations follow the ALARA(as low as reasonably achievable) principle. Ultrasound and gadolinium-free magnetic resonance imaging(MRI) are the first choices, while ionizing radiation examinations are strictly restricted. Maternal safety should be prioritized in treatments, with the second trimester being the optimal window for surgery and chemotherapy. Chemotherapy should be avoided in the first trimester. Low-risk agents such as anthracyclines and platinum-based drugs are recommended, whereas teratogenic medications are contraindicated. Radiotherapy is contraindicated during pregnancy and only cautiously administered in exceptional and rare cases. The entire management relies on multidisciplinary team(MDT) collaboration to develop individualized plans. Delivery requires comprehensive evaluation of maternal and fetal conditions, followed by timely initiation of tumor treatments for postpartum women and long-term follow-up for both maternal and child health. Standardized diagnosis and treatment combined with an MDT model can improve maternal and fetal outcomes and provide safety assurance for women of reproductive age. |
| Key words: Pregnancy Malignant tumors Multidisciplinary team Radiotherapy and chemotherapy Diagnosis and treatment strategies |
