胎儿心脏肿瘤的外科救治  

Surgical intervention for cardiac neuplasm in fetus

作　　者：庄建[1] 温树生[1] 周成斌[1] 潘薇[1] 韩凤珍[1] 孙云霞[1] 陈寄梅[1] 梁杰贤[1] 朱卫中[1] 王树水[1] 

机构地区：[1]广东省心血管疾病研究所、广东省人民医院心外科、广东省医学科学院,广州510080

出　　处：《中华胸心血管外科杂志》2016年第7期388-390,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：“十二五”国家科技支撑计划课题（2011BAI11B22）,国家自然科学基金（81370274）,广东省科技计划项目（2014A020213010）

摘　　要：目的：总结1例胎儿心脏肿瘤外科救治的临床经验。方法患者32岁，孕30＋周，发现胎儿心脏占位性病变2天，胎儿超声心动图示心脏单发不均质性占位病变，位于右心房，大小2.85 cm x2.25 cm，不能确定来源于心包还是心房内；三尖瓣环已受压50％，大量心包积液，在胎儿心脏受压明显的胎位时，出现胎心减慢现象。孕32周时实施胎盘支持下产时子宫外胎儿心脏外科救治手术。产科医师完成孕妇剖宫、胎儿脱离子宫、保留脐带和胎儿循环。胎儿正中开胸，打开心包，放出约30 ml清亮的心包积液，术中证实为右心房巨大肿瘤；由于产时子宫外胎儿手术时间有限，不能耐受体外循环，因此暂时保留右心房肿物，不缝合胸骨，确保有效缓解胎儿心脏受压情况，成功完成产时子宫外胎儿（心脏）手术后断脐娩出胎儿。生后第2天体外循环下切除右心房肿物，修补缺损的右心房。结果术后孕妇恢复良好；早产儿在心脏肿瘤切除术后血流动力学稳定，生长逐渐接近足月儿。心脏肿物的病例报告为良性血管瘤。结论通过多学科协助，在充分的术前准备下，可以安全进行产时胎儿心脏干预治疗。Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm x2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy（EXIT） procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.

关 键 词：胎儿 宫外产时处理 心脏肿瘤 心脏外科治疗 

分 类 号：R714.5[医药卫生—妇产科学]