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段涛:怀孕生孩子那些事 之 胎儿肿瘤

2017-10-12 段涛 健康界

前段时间微博和微信朋友圈被“雾霾”刷屏,视频里提到了雾霾、PM2.5和胎儿肿瘤。不少人,特别是准妈妈很关心这个话题,本来不想凑这个热闹,被问多了,索性写篇文章一并回答。

前段时间微博和微信朋友圈被“雾霾”刷屏,视频里提到了雾霾、PM2.5和胎儿肿瘤。不少人,特别是准妈妈很关心这个话题,本来不想凑这个热闹,被问多了,索性写篇文章一并回答。

其实胎儿肿瘤的发生率并不高,大约在1/12000-1/30000,远不如发生率为1-3%的出生缺陷。胎儿新生儿肿瘤分为两大类,白血病和实体肿瘤,其特点往往有别于成人。

1.多数是间质细胞瘤,不是上皮性肿瘤。

2.不少儿童期的恶性肿瘤如果是发生在胎儿期的话,其生物学行为更加偏向良性,治疗的预后也会更加好,例如神经母细胞瘤、先天性纤维肉瘤、视网膜母细胞瘤等。

3.这些肿瘤主要源自于胎儿非成熟细胞或胎儿干细胞的癌基因突变,所以又被称为胚细胞瘤或胚胎肉瘤。

胎儿新生儿肿瘤往往和基因(例如癌基因或抑癌基因)的异常有关,有些遗传病、染色体异常或遗传综合征与胎儿新生儿肿瘤密切相关,例如21三体经常发生先天性的白血病。只有小部分的胎儿肿瘤例具有家族遗传性,如大约40%的视网膜母细胞瘤。

胎儿肿瘤的发生机制比较复杂,类型和临床转归也往往有别于成人,除了遗传因素和基因突变以外,准妈妈在孕期暴露于不良因素也可能有一定的相关性。研究发现,如果母亲在怀孕时长期暴露于某些化学、物理或感染因素时,可能会触发肿瘤的发生机制,增加胎儿肿瘤的发生概率。但是其具体的发生机制还不清楚,现在还无法把胎儿肿瘤和某些特定的化学、物理或感染因素明确的联系在一起,在动物模型上的研究结果不能简单地推论到人身上。

胎儿肿瘤的诊断主要依靠影像学检查,例如超声或者是磁共振(MRI),但是体积比较小的实体肿瘤或者是白血病往往要等到婴幼儿期或儿童期才能诊断。胎儿肿瘤除了可以在相应的组织或器官发现实性或囊实性的占位病变以外,往往会导致胎儿水肿,羊水过多等症状。所以一旦出现胎儿水肿或者羊水过多,需要引起重视并进行详细的检查以除外胎儿肿瘤。胎儿肿瘤的诊断和处理单靠产科医生是不行的,应该采用MDT(多学科会诊)的模式,MDT的团队除了产科医生以外,还要包括影像科医生、小儿外科医生、肿瘤科医生、临床遗传科医生、心理医生等。

有些胎儿肿瘤其实本质上不是肿瘤,例如胎儿的血管瘤就不是肿瘤,是血管畸形;胎儿“肺囊腺瘤(CCAM)”也不是肿瘤,是“肺囊性腺瘤样畸形”。

各种胎儿肿瘤的发生率不一样,有研究者将常见的胎儿肿瘤罗列出来,计算出一个百分比,供大家参考。

神经母细胞瘤 27%

畸胎瘤 25%

白血病 12%

肉瘤 10%

脑肿瘤 9%

肾脏肿瘤 6%

视网膜母细胞瘤 6%

肝脏肿瘤 5%

神经母细胞瘤

神经母细胞瘤是胎儿新生儿婴幼儿最常见的实体肿瘤,主要源自于肾上腺髓质未分化的神经组织,具体病因不清楚。在妊娠晚期可以通过超声检查发现,可以表现为囊性、实性、或囊实性,有时会伴随出现肝脏肿大,羊水过多,胎儿水肿。神经母细胞瘤潜在恶性,预后取决于确诊时的年龄和疾病的分期。

畸胎瘤与其他生殖细胞肿瘤

畸胎瘤可以来自性腺或性腺外,性腺外的主要在身体的中线,包括骶尾部、纵膈、以及颈部,多数的性腺肿瘤为畸胎瘤。多数畸胎瘤是良性,只有不到10%的先天性生殖细胞肿瘤是恶性的。多数先天性畸胎瘤是性腺外的,最常见的部位是骶尾部畸胎瘤。

中胚叶肾瘤

是先天性肾脏肿瘤中最常见的类型,来源于肾脏间充质细胞,通常为良性。一般在超声检查时可以发现,往往合并有羊水过多,手术切除可以治愈。

Wilms肿瘤(肾母细胞瘤)

肾母细胞瘤来自于肾脏,由多种胚胎组织组成,是恶性肿瘤,有遗传性和非遗传性两种。肾母细胞瘤与很多遗传病相关,有遗传倾向,但是很少能在宫内诊断,一般在2-3岁发病。如果在胎儿期即发现,就可能是Perlman综合征的一部分,即家族性肾母细胞瘤、胎儿腹腔积液、羊水过多、肝大、巨大儿等。

视网膜母细胞瘤

视网膜母细胞瘤是儿童最常见的眼内肿瘤,虽然是先天性的,但是只有少数情况下可以在产前诊断,平均发病年龄为2岁,其特点是一旦发现,生长比较迅速。视网膜母细胞瘤为恶性肿瘤,可以是遗传性的,也可以是非遗传性的。对于有遗传风险的妊娠,可以进行产前的相关基因诊断。

结论:从现有的文献来看,没有证据证实雾霾、PM2.5和胎儿肿瘤相关;但是雾霾、PM2.5等环境污染物有可能会增加不良妊娠结局的发生率,以及对子代的远期健康造成不良的影响。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2019603, encodeId=8da22019603de, content=<a href='/topic/show?id=cc326902699' target=_blank style='color:#2F92EE;'>#生孩子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69026, encryptionId=cc326902699, topicName=生孩子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=89da2500024, createdName=1194695146_61857347, createdTime=Sat Feb 24 07:17:00 CST 2018, time=2018-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635925, encodeId=c1561635925a8, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun Dec 31 00:17:00 CST 2017, time=2017-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252223, encodeId=70fe2522237f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/iaAVWEsIJUkA1ITy3uL0lhHUhyaJibWgFtH4KbJuaLbY2WUK33jgCFyoZ8Eqx7eE7hCuZhytc1C5GRrfjVXN8lYg/0, createdBy=fcb82149579, createdName=183****7028, createdTime=Thu Oct 12 13:15:39 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252217, encodeId=7a9425221e49, content=很好的文章.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 12 12:45:08 CST 2017, time=2017-10-12, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2019603, encodeId=8da22019603de, content=<a href='/topic/show?id=cc326902699' target=_blank style='color:#2F92EE;'>#生孩子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69026, encryptionId=cc326902699, topicName=生孩子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=89da2500024, createdName=1194695146_61857347, createdTime=Sat Feb 24 07:17:00 CST 2018, time=2018-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635925, encodeId=c1561635925a8, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun Dec 31 00:17:00 CST 2017, time=2017-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252223, encodeId=70fe2522237f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/iaAVWEsIJUkA1ITy3uL0lhHUhyaJibWgFtH4KbJuaLbY2WUK33jgCFyoZ8Eqx7eE7hCuZhytc1C5GRrfjVXN8lYg/0, createdBy=fcb82149579, createdName=183****7028, createdTime=Thu Oct 12 13:15:39 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252217, encodeId=7a9425221e49, content=很好的文章.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 12 12:45:08 CST 2017, time=2017-10-12, status=1, ipAttribution=)]
    2017-10-12 183****7028

    学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2019603, encodeId=8da22019603de, content=<a href='/topic/show?id=cc326902699' target=_blank style='color:#2F92EE;'>#生孩子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69026, encryptionId=cc326902699, topicName=生孩子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=89da2500024, createdName=1194695146_61857347, createdTime=Sat Feb 24 07:17:00 CST 2018, time=2018-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635925, encodeId=c1561635925a8, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun Dec 31 00:17:00 CST 2017, time=2017-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252223, encodeId=70fe2522237f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/iaAVWEsIJUkA1ITy3uL0lhHUhyaJibWgFtH4KbJuaLbY2WUK33jgCFyoZ8Eqx7eE7hCuZhytc1C5GRrfjVXN8lYg/0, createdBy=fcb82149579, createdName=183****7028, createdTime=Thu Oct 12 13:15:39 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252217, encodeId=7a9425221e49, content=很好的文章.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 12 12:45:08 CST 2017, time=2017-10-12, status=1, ipAttribution=)]
    2017-10-12 清风拂面

    很好的文章.学习受益匪浅

    0

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