Chow Velda Ling Yu, Chan Jimmy Yu Wai, Ng Raymond Wai Man, Wei William Ignace
Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR.
Asian J Surg. 2008 Oct;31(4):199-203. doi: 10.1016/s1015-9584(08)60086-x.
Ethical dilemmas arise in managing head and neck cancers during pregnancy. The timing of treatment is an important determinant on foetal wellbeing. Diagnostic and treatment modalities may harm the foetus, while delaying or choosing suboptimal treatment in order to preserve foetal health may worsen maternal outcome. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. We report on two cases. Case 1 is a 34-year-old female who presented with squamous cell carcinoma of the tongue at 29 weeks' gestation. Partial glossectomy, selective neck dissection and posterior tibial flap reconstruction was performed at 31 weeks. She underwent induction and early delivery at 38 weeks prior to receiving radiotherapy. Case 2 is a 36-year-old female who presented with carcinoma of the cervical oesophagus complicated by tracheal invasion, thyroid and cervical lymph node metastasis at 13 weeks' gestation. Pregnancy was terminated at 16 weeks. She received a course of neoadjuvant chemoirradiation.
孕期头颈部癌症的管理中会出现伦理困境。治疗时机是胎儿健康的重要决定因素。诊断和治疗方式可能会伤害胎儿，而推迟治疗或选择次优治疗以保护胎儿健康可能会使母亲的预后变差。应采用多学科方法，使父母和临床医生能够做出最佳临床决策。我们报告两例病例。病例1是一名34岁女性，在妊娠29周时被诊断为舌鳞状细胞癌。在31周时进行了部分舌切除术、选择性颈清扫术和胫后皮瓣重建术。她在接受放疗前于38周进行了引产和早产。病例2是一名36岁女性，在妊娠13周时被诊断为颈段食管癌并伴有气管侵犯、甲状腺及颈部淋巴结转移。妊娠于16周终止。她接受了一个疗程的新辅助放化疗。
