胎儿水囊状淋巴管瘤孕妇的母儿结局分析
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摘要
目的探讨胎儿水囊状淋巴管瘤孕妇的母儿结局,指导胎儿水囊状淋巴管瘤的临床管理。方法回顾性分析2011～2015年于中国医科大学附属盛京医院住院终止妊娠的胎儿水囊状淋巴管瘤孕妇35例的病历资料,对产前超声情况、染色体核型、妊娠结局及新生儿结局进行分析。结果 35例胎儿水囊状淋巴管瘤孕妇中,28例选择引产,发现孕周11~(+5)～31~(+3)周,终止妊娠孕周14~(+5)～31~(+5)周,淋巴管瘤大小1.7～10.1 cm;其中完善染色体检查4例,2例正常,2例21-三体,合并胎死宫内5例,胎儿水肿14例,足内翻2例。7例顺利生产,发现孕周24～38~(+2)周,分娩孕周37~(+6)～40~(+1)周,染色体检查均正常,淋巴管瘤大小2.7～7.0 cm;其中阴道分娩1例,剖宫产6例;颈部5例,面部1例,腋下伴胸前1例;分别于生后2 d至1个月行介入治疗,局部注射药物后未出现相关并发症,恢复良好,按期出院,术后半年至1年返院复查肿瘤无复发,生长发育正常。结论染色体结果正常且不合并其他畸形的胎儿水囊状淋巴管瘤预后较好,切忌过早选择放弃胎儿引产终止妊娠,应密切随访,选择恰当的终止妊娠时机,介入治疗是胎儿水囊状淋巴管瘤一种良好的治疗方式。
Objective To investigate the pregnancy and pediatric outcome of pregnant women with fetal cystic hygroma, to guide the clinical management of fetal cystic hygroma. Methods Retrospective analysis of 35 cases of pregnant women with fetal cystic hygroma who were terminated in Shengjing Hospital affiliated to China Medical University from 2011 to 2015, prenatal ultrasound and chromosomal nucleus type, pregnancy outcome, and neonatal outcome were analyzed. Results Of the 35 pregnant women with fetal cystic hygroma, 28 patients chose to induce labor,who were found 11~(+5)～31~(+3) weeks of gestation, terminated pregnancy 14~(+5)～31~(+5) weeks of gestation,with lymphangioma size 1.7 ～ 10.1 cm, of which 4 cases improved the chromosome examination, 2 cases were normal, 2 cases of trisomy 21, combined with fetal death in 5 cases, fetal edema in 14 cases, and foot varus in 2 cases.7 cases of the 35 cases had smooth production, which found that 24 weeks～38~(+2) weeks of gestation, delivery at 37~(+6) weeks ～40~(+1) weeks of gestation, chromosome examination were normal, with lymphangioma size 2.7～7.0 cm. Of which 1 case of vaginal delivery, cesarean section in 6 cases;5 cases of cervical lymphangioma, 1 case of face lymphangioma, 1 case of underarm and chest lymphangioma. Interventional treatment was performed 2 days to 1 month after birth. No complications occurred after local injection of drugs. The recovery was good and discharged on schedule. After 6 months to 1 year after surgery, the tumor was reexamined without recurrence and normal growth and development.Conclusion The cystic hygroma with normal chromosome,and not associated with other fetal malformations have good prognosis. It is suggested to avoid premature induced abortion. Close follow-up should be conducted to select the appropriate timing for termination of pregnancy. Interventional therapy is a good selection treatment for fetal cystic hygroma.
Objective To investigate the pregnancy and pediatric outcome of pregnant women with fetal cystic hygroma, to guide the clinical management of fetal cystic hygroma. Methods Retrospective analysis of 35 cases of pregnant women with fetal cystic hygroma who were terminated in Shengjing Hospital affiliated to China Medical University from 2011 to 2015, prenatal ultrasound and chromosomal nucleus type, pregnancy outcome, and neonatal outcome were analyzed. Results Of the 35 pregnant women with fetal cystic hygroma, 28 patients chose to induce labor,who were found 11~(+5)～31~(+3) weeks of gestation, terminated pregnancy 14~(+5)～31~(+5) weeks of gestation,with lymphangioma size 1.7 ～ 10.1 cm, of which 4 cases improved the chromosome examination, 2 cases were normal, 2 cases of trisomy 21, combined with fetal death in 5 cases, fetal edema in 14 cases, and foot varus in 2 cases.7 cases of the 35 cases had smooth production, which found that 24 weeks～38~(+2) weeks of gestation, delivery at 37~(+6) weeks ～40~(+1) weeks of gestation, chromosome examination were normal, with lymphangioma size 2.7～7.0 cm. Of which 1 case of vaginal delivery, cesarean section in 6 cases;5 cases of cervical lymphangioma, 1 case of face lymphangioma, 1 case of underarm and chest lymphangioma. Interventional treatment was performed 2 days to 1 month after birth. No complications occurred after local injection of drugs. The recovery was good and discharged on schedule. After 6 months to 1 year after surgery, the tumor was reexamined without recurrence and normal growth and development.Conclusion The cystic hygroma with normal chromosome,and not associated with other fetal malformations have good prognosis. It is suggested to avoid premature induced abortion. Close follow-up should be conducted to select the appropriate timing for termination of pregnancy. Interventional therapy is a good selection treatment for fetal cystic hygroma.
引文
[1] Gedikbasi A, Gul A, Sargin A, et al.Cystic hygroma and lymphangioma: associated findings, perinatal outcome and prognostic factors in live-born infants [J].Arch Gynecol Obstet, 2007, 276(5): 491-498.
[2] Papp C, Bán Z, Szigeti Z, et al.Prenatal sonographic findings in 207 fetuses with trisomy 21[J].Eur J Obstet Gynecol Reprod Biol, 2007, 133(2): 186-190.
[3] Sepúlveda WH,Ciuffardi I.Earlysonographic diagnosis of fetal cystic hygroma colli [J].J Perinat Med, 1992, 20(2): 149-152.
[4] Graesslin O, Derniaux E, Alanio E, et al.Characteristics and outcome of fetal cystic hygroma diagnosed in the first trimester [J].Acta Obstet Gynecol Scand, 2007, 86(12): 1442-1446.
[5] Santo S, Marques JP, Veca P, et al.Prenatal ultrasonographic diagnosis of abdominal cystic lymphangioma: a case report [J].J Matern Fetal Neonatal Med, 2008, 21(8): 565-566.
[6] Hyett J, Sonek J, Nicolaides K, et al.Nuchal translucency and the risk of congenital heart disease [J].Obstet Gynecol, 2007, 109(6): 1455-1456;author reply 1456-1457.
[7] Malone FD, Ball RH, Nyberg DA, et al.First-trimester septated cystic hygroma: prevalence, natural history, and pediatric outcome[J].Obstet Gynecol, 2005, 106(2): 288-294.
[8] Sanhal CY, Mendilcioglu I, Ozekinci M, et al.Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma[J].Brazilian Journal of Medical and Biological Research, 2014, 47(9): 799-803.
[9] 李欢,张志涛,刘彩霞,等.胎儿淋巴管瘤治疗方法的临床探讨[J].中国妇幼保健,2013,28(6):944-948.
[10] Temizkan O, Abike F, Ayvaci H, et al.Fetal axillary cystic hygroma: a case report and review [J].Rare Tumors, 2011, 3(4): e39.
[2] Papp C, Bán Z, Szigeti Z, et al.Prenatal sonographic findings in 207 fetuses with trisomy 21[J].Eur J Obstet Gynecol Reprod Biol, 2007, 133(2): 186-190.
[3] Sepúlveda WH,Ciuffardi I.Earlysonographic diagnosis of fetal cystic hygroma colli [J].J Perinat Med, 1992, 20(2): 149-152.
[4] Graesslin O, Derniaux E, Alanio E, et al.Characteristics and outcome of fetal cystic hygroma diagnosed in the first trimester [J].Acta Obstet Gynecol Scand, 2007, 86(12): 1442-1446.
[5] Santo S, Marques JP, Veca P, et al.Prenatal ultrasonographic diagnosis of abdominal cystic lymphangioma: a case report [J].J Matern Fetal Neonatal Med, 2008, 21(8): 565-566.
[6] Hyett J, Sonek J, Nicolaides K, et al.Nuchal translucency and the risk of congenital heart disease [J].Obstet Gynecol, 2007, 109(6): 1455-1456;author reply 1456-1457.
[7] Malone FD, Ball RH, Nyberg DA, et al.First-trimester septated cystic hygroma: prevalence, natural history, and pediatric outcome[J].Obstet Gynecol, 2005, 106(2): 288-294.
[8] Sanhal CY, Mendilcioglu I, Ozekinci M, et al.Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma[J].Brazilian Journal of Medical and Biological Research, 2014, 47(9): 799-803.
[9] 李欢,张志涛,刘彩霞,等.胎儿淋巴管瘤治疗方法的临床探讨[J].中国妇幼保健,2013,28(6):944-948.
[10] Temizkan O, Abike F, Ayvaci H, et al.Fetal axillary cystic hygroma: a case report and review [J].Rare Tumors, 2011, 3(4): e39.