13例原发性胸腔积液胎儿产前治疗的临床分析  

Clinical analysis of prenatal diagnosis and intervention for primary pleural effusion of 13 cases

作　　者：王雪勤[1] 李玮璟[1] 闫瑞玲[1] 向静文[1] 刘梦媛[1] 

机构地区：[1]暨南大学附属第一医院胎儿医学科,广州510630

出　　处：《中华妇产科杂志》2018年第2期82-87,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的通过比较不同的产前治疗方法对原发性胸腔积液（PFHT）胎儿存活率的影响，以期优化产前对PFHT胎儿的临床管理措施。方法收集2009年7月至2015年12月在暨南大学附属第一医院就诊、产前诊断为PFHT的胎儿13例，分别进行产前期待治疗、胸腔穿刺抽液术（TC）、胸腔羊膜腔分流术（TAS）后，比较不同产前治疗方法的新生儿存活率。结果13例PFHT胎儿中，积液自行吸收或保持稳定者2例（2/13），积液进展者11例（11/13）。期待治疗6例（2例因积液进展选择终止妊娠，2例胎死宫内，2例足月分娩），新生儿存活率为2/6；TC治疗6例（2例足月分娩，2例早产，2例积液进展终止妊娠），新生儿存活率为4/6；TC＋TAS治疗1例（足月分娩），新生儿存活率为1/1；产前宫内干预后总的新生儿存活率为5/7。结论PFTH的临床表现复杂多样，积液多随孕周进展，预后难以预测，实施宫内干预可提高新生儿的存活率。Objective To optimize the clinical managements of primary fetal hydrothorax （PFHT） fetus by comparing the perinatal survival rate of different prenatal treatments.Methods Totally 13 fetuses diagnosed with PFHT from July 2009 to December 2015 in the First Affiliated Hospital of Jinan University were collected and received prenatal expectant treatment, thoracocentesis （TC）, and thoraco-amniotic shunting （TAS）, respectively. The perinatal survival rate was compared among the three treatments.Results Among 13 fetuses of PFHT, pleural effusion was absorbed or remained stable in 2（2/13） cases, and progressed in 11（11/13） cases. Six cases received expectant treatment （2 cases had termination of pregnancy due to progressing effusion, 2 cases had term delivery, and 2 cases had intrauterine death）; the perinatal survival rate was 2/6. Six cases received TC （2 cases had term delivery, 2 cases had preterm delivery, and 2 cases had termination of pregnancy due to progressing effusion）, the perinatal survival rate was 4/6. One case received TC＋TAS （term delivery）, the perinatal survival rate was 1/1. The overall perinatal survival rate of prenatal intrauterine intervention was 5/7.Conclusions The clinical process of PFHT is changeable, and the pleural effusion will progress with gestational age. Intrauterine interventions could improve the perinatal survival rate.

关 键 词：胸腔积液 产前诊断 存活率 

分 类 号：R714.5[医药卫生—妇产科学]