胎儿血栓性血管病的胎盘病理及其临床结局  

The Pathological Features and Perinatal Outcome of Fetal Thrombotic Vasculopathy in Placenta

作　　者：赵学军 刘伯宁[2] 王忠英 李冰 

机构地区：[1]上海市长宁区妇幼保健院,上海200051 [2]上海交通大学附属第六人民医院,上海200233

出　　处：《实用妇产科杂志》2010年第12期924-927,I0001,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨胎盘中胎儿血栓性血管病(fetal thrombotic vasculopathy,FTV)的病理特征及围生儿临床结局。方法:2008～2009年临床送检的孕晚期孕妇胎盘标本中经病理证实存在无血管绒毛及(或)血栓的病例21例,其中符合FTV诊断11例,对其行临床与病理分析。结果:11例FTV中临床发现:脐带异常6例,包括脐带过长、脐带绕颈、脐带螺旋明显和脐带真结。巨检发现:脐带边缘附着5例,脐带螺旋明显4例,胎盘切面见淡红色区2例,血管内见血栓1例。镜检:11例FTV中10例见多灶性无血管绒毛,肉眼可见血栓的1例,其血管供应区的绒毛毛细血管普遍闭塞,但尚未形成典型的、玻璃样的无血管绒毛。11例FTV中围生儿临床结局:死胎2例,早产5例,低体重儿5例,新生儿窒息1例、新生儿高血红蛋白血症1例。结论:脐带异常是FTV发生的重要因素,重视FTV的病理诊断、病理鉴别诊断和对临床结局的不良影响,注重对FTV患儿的远期随访。Objective：To investigate the pathologic features and perinatal outcomes of fetal thrombotic vasculopathy（FTV）. Methods：11 cases of FTV among 21 cases with avascular villi and/or thrombosis in third trimester placentas during 2008～2009 were reviewed,including the clinical and pathological features. Results：Among the 11 cases,six cases of abnormal Umbilical cord were found,including excessive long cord,umbilical cord around the neck,twisted cord,and true knot on umbilical cord. Macroscopically,it was found that five cases with marginal cord insertion,four cases with twisted cord,two cases with pink area on section,one case with thrombosis. Microscopically,it was found that 10 cases with multiple areas of avascular villi,one case with thrombosis and obliterated capillaries. Perinatal outcomes included the following situations：two cases with intraurine fetal demise,five cases with prematurity,five cases with low birth weight,one case with neonatal asphyxia,one case with neonatal polycythemia. Conclusions：Umbilical cord abnormality is the important predisposing factor for FTV. More attention should be paid to the diagnosis,differential diagnosis and its poor outcomes,especially,the long term follow up for neonate with FTV.

关 键 词：胎盘 胎儿血栓性血管病 无血管绒毛 

分 类 号：R714.5[医药卫生—妇产科学]