子宫外产时处理胎儿颈部巨大占位的临床初探  

Use EXIT （ex-utero intrapartum treatment） procedure in the treatment of fetal neck mass

作　　者：沈淳[1] 王炫[1] 郑珊[1] 李笑天[2] 任芸芸[2] 

机构地区：[1]复旦大学附属儿科医院,上海201102 [2]复旦大学附属妇产科医院

出　　处：《中华小儿外科杂志》2011年第6期401-404,共4页Chinese Journal of Pediatric Surgery

基　　金：国家科技支撑计划《严重结构异常的筛查、诊断和治疗规范化方案的研究》2006BA105A00卫生部临床重点学科项目《新生儿重症畸形的诊断和治疗研究》（卫规财函[2007]353号）

摘　　要：目的探讨子宫外产时处理（EXIT）技术治疗胎儿颈部巨大肿块的临床应用。方法2（）07年9月至2010年2月，选择性对4例产前诊断颈部巨大占位合并羊水过多、气管受压／受压不明确的胎儿实施EXIT技术。分析其病因、生后气管受压、术前依赖机械通气等情况，初步评估EXIT技术对胎儿颈部巨大占位预后的影响。结果男女比例3：1，足月，择期分娩。3例术前依赖机械辅助通气，增强CT提示气管明显受压及推移，最严重者出现口咽腔受压变狭窄。3例患儿新生儿期手术治疗，1例未手术。诊断肠源性囊肿1例、淋巴管瘤2例及梨状窝瘘1例。随访6～36个月预后良好。结论胎儿颈部占位以淋巴管瘤、畸胎瘤多见，其他如肠源性囊肿、梨状窝瘘或食管重复畸形等少见。多数颈部占位可对气道产生压迫及推移，严重者影响呼吸。EXIT技术可为胎儿出生即刻提供良好通气状况，最大程度减少缺氧发生。颈部占位胎儿接受EXIT技术分娩，多数预后良好，转归令人满意。Objective To discuss the role of EXIT （ex-utero intrapartum treatment） procedure in the treatment of fetal neck mass. Methods Form 2007, 9 to 2010, 2, 4 fetus were selected, those diagnosed neck huge mass with polyhydramnios in prenatal period. After term pregnancy, they were delivered by EXIT procedure in Obstetrics ＆ Gynecology Hospital and follow-up in our Children＇s hospital. All information of the neck mass, mass of air pressure on the circumstances, the preoperative on mechanical ventilation was recorded, and the effect and prognosis of these patients were evaluated. Results Boy： girl： 3：1. They all delivered by EXIT procedure after full term. Three cases depended on the mechanical ventilation before the operation. Enhance CT showed trachea obviously compressed and lapsed. The most serious patient was found the pharynx under pressure. Those 3 cases had operations in neonatal period. The other one case had no operation and follow-up in clinic department. Four cases were diagnosed as enterogenous cyst 1 case, lymphangioma 2 cases and pyriform sinus fistula 1 case. Conclusions EXIT procedure would provide a ventilation pathway for baby with reduced hypoxi- a. Fetal with neck mass delivered by EXIT procedure will get good prognosis, the treatment results will be satisfactory.

关 键 词：胎儿分娩 颈 预后 

分 类 号：R714.5[医药卫生—妇产科学]