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北京版《人世间》:怀孕5个月查出宫颈癌,她一边化疗一边保胎

2017-06-19 戴戴 医生医事

这是一年前遇到的故事,完稿时治疗还未结束,因此文章在后台存放至今。现在,另一只鞋子终于落下,这个故事也可以讲了。

这是一年前遇到的故事,完稿时治疗还未结束,因此文章在后台存放至今。现在,另一只鞋子终于落下,这个故事也可以讲了。

还记得2016年7月播出的医疗纪录片《人世间》第九集《爱》所纪录的那个真实故事吗?



(医疗纪录片《人世间》第九集《爱》的镜头:宝宝亲吻妈妈)

怀孕5个月的上海姑娘张丽君,被诊断出罹患胰腺癌,她拒绝了医生引产的建议,坚持生下宝宝后才开始接受治疗,然而等她的孩子出生时,癌细胞已经全身扩散,早已失去了手术的时机。纪录片真实记录了这位母亲的坚强,这是一份礼物,也是一种告别。命运果然没有出现奇迹,几个月后,她离开了人世。



(截屏:医疗纪录片《人世间》第九集《爱》)

而今天,我要说的却是另一个发生在北京的年轻妈妈的故事——与张丽君一样年轻美丽,也和她几乎同时抓到了同一付“烂牌”。

去年7月,因“遇见肿瘤大咖”专栏,在采访北京大学人民医院妇产科魏丽惠教授时,我遇到了李悦(化名)。

李悦与上海的张丽君,几乎同时怀孕,孕5个月时都查出罹患癌症,张丽君是胰腺癌,李悦是宫颈癌。她们都决定,保全腹中的孩子。

上海的张丽君担心化疗会影响胎儿发育,决定在宝宝出生后再治疗;

而北京的李悦,北大人民医院妇产科的医生们给了她另一种选择的可能:一边化疗控制肿瘤,一边保胎,直到孩子出生,李悦再继续全面肿瘤治疗。

我遇到李悦时,她的孩子出生已经快6个月,各方面都很健康,而她本人正处于肿瘤治疗的关键时期。为了不影响她的治疗,我并未打扰她。

文章写完送魏丽惠教授审稿时,她和团队里参与治疗的医生们商量后,谨慎地决定,还是等治疗结束再发表,因为“治疗过程很艰苦,大家都还在努力”。这篇文章就一直存放在后台。

如今,李悦的治疗已经完成,取得很好的效果,她的孩子已经17个月大,很健康。魏丽惠教授的团队,将李悦的病例写成文章,作为病例讨论发表在2017年3月的《中国妇产科临床杂志》上。

这个故事也终于可以讲给大家听了。

李悦怀孕后总是阴道出血、白带增多,刚开始以为是先兆流产,后来查出竟然是局部晚期宫颈癌。2015年10月左右,她找到魏丽惠教授时,已怀孕20周。

如果按照常规治疗,李悦必须终止妊娠,做根治性手术。然而,这样就意味她着将永远无法再生育自己的孩子,而她才24岁,人生刚刚开始。

李悦求医生让自己把孩子留下来。

魏丽惠教授陷入两难。要保证孕妇本人的肿瘤不继续恶化,需要进行全身化疗,而化疗药物有潜在的致畸和流产风险?又要化疗又保证胎儿的安全,这对于医生来说,是一个巨大的挑战。

(《遇见·魏丽惠|是女人,更是女人的医生》)

年过七旬的魏丽惠教授,是我国妇科肿瘤领域的著名专家,曾担任北大人民医院妇产科主任28年,近10余年,一直致力于宫颈癌的筛查和治疗。以前,遇到妊娠合并宫颈癌的患者,医生都是用常规的治疗方法,即终止妊娠,然后进行抗肿瘤治疗。

大家也许还记得演员李媛媛,她也是在怀孕期间阴道出血,一直当作是先兆流产,直到孩子出生后,她被诊断出是宫颈癌中晚期。由于孕期未及时治疗,病情快速发展,失去了最佳的治疗机会,仅存活了两年,于2002年去世。

根据李悦的病情,如果要控制肿瘤不继续恶化,就需要马上进行化疗,但化疗药物是否会对胎儿造成危害,魏丽惠教授不知道。这样的非常规治疗,国内的医生还没有人尝试过。

实际上,与李悦前后脚,魏教授还接诊了一名26岁的妊娠合并子宫颈癌1期的患者李欣(化名),也是在孕20周时查出宫颈癌,也要求留下孩子。

魏教授带领医生们查找了很多文献,找到了国外妊娠期化疗的依据,然后谨慎地对李欣使用了这种非常规的治疗方法。李欣在2015年12月把孩子安全地生了下来,医生们对孩子进行了各种检测,一切指标均正常。

有了这一例的信心,再加上李悦和家人的充分信任,魏教授和全科的医生也决定陪李悦一起“走钢丝”。

对医生来说,使用常规的治疗方案,责任最小,而选择这样的非常规治疗方法,则要冒极大风险。

在李悦的妊娠期,医生一共给她做了3个疗程的化疗,要这么长时间保证胎儿和母亲两个生命的安全,医生们内心承受着巨大的压力,如履薄冰,小心翼翼。

有一天,想着李悦的病情,魏教授突然睡不着,大半夜给化疗病房负责人李小平教授打电话,讨论李悦的病情。而为了这一个病例,王建六主任和魏教授带领全科室医生集体讨论了至少3次。

魏丽惠教授还把自己的私人微信号留给了李悦,以便李悦有异常随时联系,魏教授也随时关注她化疗后的反应,并叮嘱她注意事项。

在2016年春节前,李悦达到孕31周,医生判断此时出生孩子存活率较高了,可以终止妊娠了。但李悦找到魏教授,说希望再等等,想生一个猴宝宝。魏教授又答应了,继续为李悦肚子里的小宝宝保驾了一个月。

过完春节,李悦怀孕已经35周。2016年2月16日,也就是春节长假后上班的第二天,北大人民医院妇产科给她实施了剖宫产手术,她如愿生下了一个名“小猴宝宝”,而且各项检测均正常。

李悦产后2周,就开始全力以赴地抗肿瘤治疗。从医生的总结文献中可以看出,李悦在产后半年内,进行了29次放疗10次化疗4次动脉介入治疗。

产后如此高强度的治疗是非常艰苦的,她都咬牙扛了过来。李悦的坚强,让魏丽惠教授等所有医生都十分感动。

在去年7月采访魏教授时,我曾两次见到李悦。第一次是在跟随魏丽惠教授查房时,当时李悦在住院,穿着大大的病号服,刚刚完成一次介入治疗,显得有些憔悴。第二次再见她时,是在魏教授的门诊,她已经出院,戴着假发,清秀的面容,大大眼睛一直带着笑意。

上天没有辜负她和孩子以及医生们的努力,她的治疗取得满意的效果,各项指标都已正常。曾在腹中和妈妈一起经历化疗药物的孩子,如今已经17个月,儿科进行了多次评估,生长发育情况都很好。

魏教授在《新英格兰》杂志上看到一篇文章,随访了105例妊娠期化疗后出生的孩子,最大的已经36个月,认知度、发育各方面都良好,孩子很健康。

这让魏教授和医生们充满信心,并将对孩子和李悦继续随访。

这是一条在中国尚无人走的路,已经取得阶段性成果,魏丽惠教授和她的医生们为这样的女性患者闯出一条希望之路。

为了孩子,为了更长久地陪伴年幼的孩子,这个25岁的妈妈爆发出了惊人的意志力和求生欲;为了两个生命,这群医生也爆发出了强烈的责任心和对医学无尽的追求。

两次见到李悦,都听到她和妈妈一次又一次地感谢医生。

魏丽惠教授说:“我很感动,他们为孩子这么努力。作为医生,在癌症与妊娠之间面临选择;是神话,还是现实;我们是挽救一个病人的生命,还是丧失一个做母亲的未来。医生的职责令人深思。”

对于医生来说,这种踩着钢丝的成就感,别人是难以体会的。尤其肿瘤治疗都是摸索,最终结果如何,谁也无法确定。

这才是医患本来的样子,彼此信任,共同努力携手对抗疾病。

这才是生命本来的样子,保持希望却不苛求,从容面对生死。

我希望,这篇文章,能给李悦的抗癌之路送上祝福,愿她和孩子健康快乐。

最后,魏丽惠教授也提醒所有女性,备孕期间应该进行宫颈癌筛查,如果一年内没有筛查者,应该在怀孕早期及时进行。

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    学习了,不懈追求,谢谢分享

    0

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    2017-06-21 一闲
  3. [GetPortalCommentsPageByObjectIdResponse(id=214022, encodeId=873121402253, content=学习了,不懈追求,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Thu Jun 22 18:56:27 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408037, encodeId=c4f4140803e71, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Wed Jun 21 02:53:00 CST 2017, time=2017-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213074, encodeId=05fc2130e4a2, content=认真学习,不断进步,把经验分享给同好。点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Jun 20 10:06:36 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212929, encodeId=2fcf212929ad, content=感谢分享!继续关注!, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Tue Jun 20 00:57:01 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212743, encodeId=acf7212e4336, content=母爱是世界上最伟大的, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3y0wtVb3TiaGMRTicAPzyz0txsXSt2YBZ5IyUGpmBJdsIIicrOzlBEMXXUcnUPkCldhS2gcCQ0rkL57A/0, createdBy=07221675788, createdName=妈妈说名字很长就能轻易找到女朋友, createdTime=Mon Jun 19 13:35:34 CST 2017, time=2017-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212732, encodeId=4162212e3259, content=不错的,学习了,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Mon Jun 19 13:08:21 CST 2017, time=2017-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212728, encodeId=ff73212e28e5, content=母亲太伟大了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Mon Jun 19 12:40:38 CST 2017, time=2017-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212725, encodeId=7cc2212e2575, content=这么说妊娠期化疗相对安全可行?, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/04/24/1c2dbd6706e64df33befd6663f1d6b37.jpg, createdBy=94f61661779, createdName=lyh994, createdTime=Mon Jun 19 12:27:03 CST 2017, time=2017-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212724, encodeId=cba1212e24ff, content=此篇文章说明母爱是无私的,医学不断发展创新, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuF63NQckT5BOaic1el7cRelbpr859YXtZQHQSaWnqZCRPOZzDBcjsBNx7AFefLHh1UvMPS4kPP0BG/0, createdBy=47831990981, createdName=1e1a50a1m36(暂无匿称), createdTime=Mon Jun 19 12:23:37 CST 2017, time=2017-06-19, status=1, ipAttribution=)]
    2017-06-20 ylzr123

    认真学习,不断进步,把经验分享给同好。点赞了!

    0

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    2017-06-20 明天会更好!

    感谢分享!继续关注!

    0

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    2017-06-19 妈妈说名字很长就能轻易找到女朋友

    母爱是世界上最伟大的

    0

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    2017-06-19 中医痴

    不错的,学习了,谢谢分享!

    0

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    2017-06-19 邓启付

    母亲太伟大了!

    0

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    2017-06-19 lyh994

    这么说妊娠期化疗相对安全可行?

    0

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    2017-06-19 1e1a50a1m36(暂无匿称)

    此篇文章说明母爱是无私的,医学不断发展创新

    0

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